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Full text of "On diseases of the generative system"

THE 

ABNER WELLBORN CALHOUN 

MEDICAL LIBRARY 

1923 



CLASS- 




BOOK- 



PRESENTED BY 



■% 



V' 






ON 



DISEASES 



OF THS 



GENERATIVE SYSTEM. 



. 3(lfoj8trattD 
WITH TWELVE PLATES. 



cAT ^-^-*v- 



/in 



BT 



JOHN ROBERTON, 

Late of Edinburgh. 

AUTHOR OF THE PRACTICAL TREATISE ON THE INTERNAL USS 
OF CANTHAKIDES IN GLEET, SEMINAL EMISSION, 
lEUCORRH^Aj 8iC. AND ON STRICTURE. 



LONDON: 
PRINTED FOK J. J. STOCKDALE, No. 41, PALL-MALL. 

181 J. 






J. HIIETTELL, Prh^TM^; 
•treet, Golden-Square, London. 



DR. BAILLIE. 



Dear Sin, 

W&ex I first proposed to dedicate this 
book to you, it did not occur to me that Mr. Home, 
whose opinions are freely discussed in the course of it, 
is your relative. But, when you permitted me to ad- 
dress it to you, you evinced your conviction, that, in 
such discussions, personal or private motives have not 
influenced my conduct. It is not, indeed, the person- 
al or private, hut the published opinions (done, of 
authors, that I have examined. 1 knoxv edso that lam, 
in common with others, liable to similar treatment ; 
and I am sure I shall feel no other emotion, in having 
my own errors pointed out, than that which excite to 
the correction of them on the first opportunity. 

From Mr. Home's doctrines indeed being so close- 
ly allied to the subject of the present publication, an 
examinution of his opinions was absolutely necessary 
to my plan, But I do assure you, that, although I 
have spoken of them with perhaps some severity, I feel 
the highest respect for the industry and scientific re- 
searches of that gentleman. His labours in Compa- 
rative Anatomy will at all times deservedly place him 
high in public estimation, 



In dedicating, then, this work to you, I cannot 
help remarking, that I* am perhaps influenced by other 
sensations, and actuated by different feelings, from 
those usually felt on similar occasions. In the earlier 
periods of my life, 1 listened with the most lively in- 
terest to the tales of my native village, respecting the 
toils and difficulties, in the midst of which, and con- 
sequently in unnoticed obscurity, those celebrated men, 
Dr. William Hunter, Mr. John Hunter, and Dr. Cul- 
len, struggled to arrive at that celebrity which at last 
they attained ; and I contemplated with delight their 
xoell-earned fame. Such reflections, even now, make 
me proud of having been brought up in the place 
which gave birth to such distinguished characters. 

Permit me to add, that the gratifying reflection of 
your also being a native of that place, on which, 
from your justly acquired fame, you have been ena- 
bled, annually, to confer so many marks of your be- 
nevolence, gives me greater pleasure than I shall hers 
attempt to describe. 

Reflecting on you all, as models for the imitation^ 
of those who follow you in the same honourable careefn 
I subscribe myself, with the greatest respect and 
esteem, 

Dear Sib, 

Your moat obedient, 

And very humble Servant, 

JOHJV ROBERTOX. 

Gi, Jermyn Street, 
St. James's. 



CONTENTS. 



PART I. 

ANATOMY. 



CHAP. I. 

Anatomy of the Urinary Organs P. 1 

CHAP. II. 

Anatomy of the Male Organs of Generation 3 

CHAP. III. 

Anatomy of the Female Organs of Generation .... 8 



PART II. 

PHYSIOLOGY. 

CHAP. I. 
Physiology of the Urinary Organs 12 

CHAP. II. 

Physiology of the Male Organs of Generation . . ib 

CHAP. III. 

Physiology of the Female Organs of Generation . . 15 



VI CONTENTS. 

CHAP. IV. 

Physiology of the Generative Organs common to 
loth Sexes P. 1 7 



PART III. 

PATHOLOGY. 

CHAP. I. 

Pathology of the Urinary Organs. 
Suppression, Retention, and Incontinence of Urine 19 

CHAP. IT. 

Pathology of the Male Organs of Generation. 

Seminal Emission . , 22 

Disease of Prostrate Gland 7 33 

Gleet J 

Spasmodic Stricture 4<> 

Permanent Stricture 50 

Fistula in Perincea 5 7 

CHAP. III. 

Pathology of the Female Organs of Generation. 

General Observations ... > 60 

Leucurr/wa 61 

Chlorosis 83 

Dysmenorrhea. — Menorrhagia 84 

CHAP. IV. 
Pathology common to loth Sexes. 

Gonorrhoea • • 8 7 

Lues Venerea 103 



PART IY. 

TREATMENT. 
Introductory Remarks 1 2S 



CONTENTS. Vil 

CHAP. I. 

Treatment of Diseased Urinary Organs. 

Of Suppression, Retention, and Incontinence of Urine . 141 

CHAP. II. 

Treatment of Male Organs. 

Seminal Emission 147 

Diseased Prostate Gland 1/2 

Spasmodic Stricture ] y 1 

Permanent stricture Q\Q 

Fistula in Perincea 228 

CHAP. III. 

Treatment oj Female Organs. 

Leucorrhoea 230 

Chlorosis, Di/smenorr/usa, and Menorrhagia 255 

CHAP IV. 

Treatment common to loth Sexes. 

Gonorrhoea 280 

Lues Venerea 303 

APPENDIX I. 

Critical Examination of Mr Home's Works on Stricture 
in the Urethra, ac 360 

APPENDIX II. 

Ulcers, Eruptions, &c 3S9 

APPENDIX III. 

Effects of the Cantharides, with Rules for their Admu 
nistration. 423 



The reader is requested to correct the following Errata, 
which, with perhaps some few other trifling errors, have, in 
the hurry of professional duty, been overlooked. 

Tage. line. 

1 2 from the bottom, for into the read several. 
IS 7 from the bottom, for jimhricated read fimbriated. 
CO Top of the page, insert Chap. III. Pathology of the Female Organs 

of Generation. 
72 9 from the bottom, for cathartus read cathartics. 
100 17 from the bottom, for case read cause. 
148 5 for more read less. 

153 10 for half a dram read half an ounce. 

154 14 for gleet read gleety. 

154 8 from the bottom, insert two ounces 
178 6 from the bottom, for glans read glands. 
185 8 for -willing read unwilling. 

195 14 from the bottom, after disease read has occasioned.' 

196 5 for depositation read deposition. 

222 9 from the bottom, for proves read prove. 

233 9 from the bottom, for wore read most. 

268 10 read 'with her rapidly encreasing, &c. 

274 last line, for half an ounce read half a dram. 

289 5 from the bottom, for glans read glands. 

292 17 from the bottom, for found read find. 

295 24 after of insert mucilage of 

303 11 from the bottom, for preventatives read preventives. 

311 6 from the bottom, for pressure teadprepuce. 

318 7 for disposition read disposed. 

332 1 from the bottom, for either read whether. 

352 12 from the bottom, insert the mouth after as<& 

424 19 dele them. 



INTRODUCTION. 



-Ill otwithstanding the multitude of books; 
pamphlets, &c. on medical subjects, with which 
the world has already been favoured, and which 
are daily issuing from the press, it appears to* 
me, that a rational examination respecting the 
nature and treatment of many of the diseases of 
the Generative System has been too much ne- 
glected. The practice adopted in them has con- 
sequently been very often unsuccessful ; and; 
viewing it even in its most favourable light, if 
the original affection may have been removed, 
the means employed have too often given origin 
to other diseases of a more unpleasant nature than 
the one for the removal of which such treatment 
Was applied. Of this, I have witnessed many 
instances, particularly in cases of the disease er- 
roneously termed Permanent Stricture, — a name 
now ridiculously applied to too many diseases of 
these parts Indeed, the opinions inculcated, and 
rules of practice advanced, in many of these 



X 

publications, modern as well as ancient, are 
fraught with what I conceive to be nearly ap- 
proaching to absurdity, and demonstrate, at a 
single glance, the ignorance of their authors re- 
specting those laws of the animal economy, with 
which every one ought to be well acquainted, 
before he attempts to prescribe for any impor- 
tant disease. 

In following many of the rules of these wri- 
ters, and in attempting to imitate their too often 
confused and improbable statements, disappoint- 
ment, such as frequently happened with myself, 
must have been experienced by others in a varie- 
ty of instances. It was the frequent repetition 
of such unpleasant occurrences, in my treatment 
of these important and very general diseases, 
that first convinced me of the necessity of exer- 
cising some independence of thought in my 
reasoning and practice ; and of following those 
rules alone which would be supported by such 
reasoning as might of itself be at least as easily 
understood, as the rules which it inculcated. 

The chronic diseases, to be examined in this 
work, (a brief account of a few of which I some- 
time ago laid before the public), were, previous 
to that period, either secretly felt, or openly 
avowed, to be incurable. But it affords me no 
small degree of gratification, to find, that, where- 
ever the liberal and candid have patiently follow- 
ed the mode of cure pointed out by me, they 



65 

vessels of the uterus ; and if such debility and dila- 
tation increase the flow of blood, however altered 
or modified, from the minute vessels, from which 
the menstrual discharge proceeds, it may equally 
encrease the discharge from the disordered muci- 
parous glands- And when it is known, from actual 
observation, that not only the uterus becomes weak, 
spongy, and flaccid, towards the approach of men- 
struation, but that the whole system is sensibly en- 
feebled ; we shall not be surprised, that about this 
time the mucous discharge should be augmented. 
Accordingly, we can easily perceive how the leu- 
corrhoeal discharge should, (as the Doctor 2dly 
observes), appear, " chiefly, and often only, a little 
before, as well as immediately after the flow of the 
menses," and yet may have a totally differeht ori- 
gin. That which may cause the apparent increase 
of the leucorrhceal discharge, shortly before and 
after the flow of the menses, is, the circumstance 
that, even in health, the menstrual flux is both pre- 
ceded and followed by a serous discharge, which, 
mixing with that of leucorrhosa, may, at such time, 
give it an appearance of temporary increase. 

That which will much invalidate the second 
reason adduced by the Doctor, is, that the leucor- 
rhceal discharge is aggravated at any time between 
the menstrual periods, and consequently indepen- 
dent of them, by passions of the mind, by hysteric 
attacks, by fatigue, &c. ; and that the disease hap- 
pens even before puberty, when the vessels neither 
doj nor ought to pour out the menses. 

The 3d argument, " From the flow of the men- 
ses being diminished, in proportion as the leucor- 
rhoea is increased ;" is strangely in exact opposition 
to the first, — " from its happening to those subject 
to an immoderate flow of the menses ;" and also to 
his opinion, that " that flow of the menses may ge- 
nerally be considered as immoderate, which is pre- 
ceded and followed by leucorrhcea j ' and it is even 

E 



contrary to experience ; for the menses do not, 
when leucorrhoea commences, necessarily diminish 
either in quantity or in duration, but are on the 
contrary, often more copious, of longer duration, 
and in every respect more distressing than in health; 
and indeed the Doctor himself elsewhere tells us, 
" that it is sometimes accompanied with a consider- 
able degree of menorrhagia, producing very re- 
markable effects ;" and, it is a fact that, in propor- 
tion as the leucorrhoea is removed, the menses re- 
turn to their wonted limits, both as to time and 
quantity. 

Though leucorrhoea even continued after men- 
struation, that circumstance would not indicate that 
they were both execreted from the same vessels ; 
for the leucorrhoea might be expected to continue 
independently of the menstruation, and the appa- 
rent consentaniety of both, might be owing to the 
periodical return of that delibity which is absolute- 
ly necessary to the existence of both. 

That there may be an increased discharge of se- 
rum from those vessels which pour out the menses, 
I am not inclined to question ; for it is not difficult 
to believe, that the serous flow, which both pre- 
cedes and follows the menses, may, even at other 
periods, be occasionally augmented in a very great 
degree, just as the menstrual discharge itself is ; or 
even that this discharge may at one time be more 
diluted with serum than at another. And if I were 
allowed to conjecture, I would say, that it is proba- 
ble, that those leucorrhoeas, if they may be so term- 
ed, which observe a periodical recurrence, are of 
this nature ; but that such a discharge is the one 
which constitutes the characteristic symptom of the 
fluor albus, properly so called, facts will not permit 
us to suppose for a moment. 

That leucorrhoea produces the same debilitating 
effects as menorrhagia, does by no means indicate 
that both discharges proceed from the same ves- 
sels ; it only shews, that the two complaints affect 



G7 

the general constitution in a similar way. Many 
other diseases, very different from one another, pro- 
duce nearly the same effects on the general system, 
and, in this respect, menorrhagia and amenorrhoea 
agree. 

That the discharge is not preceded nor accom- 
panied with symptons of any topical affection of 
the uterus, shews, that the disease comes on some- 
times when we do not expect it, but, by no means, 
that the discharge proceeds from the same vessels. 

Nor can this be rendered probable, by the dis- 
charge not succeeding venereal infection, or local 
inflammation, any more than that the discharge 
of gleet in males should proceed from the seminal 
vessels, when unpreceded by gonorrhoea. 4 

But there are many facts which shew, that the 
leucorrhceal discharge does not proceed from the 
vessels which give out the menses. The discharge 
is precisely similar to that which appears when the 
mucous membrane of the urethra in the male is in 
a state of disease ; such discharge is not necessarily 
present in menorrhagia. 

Leucorrhoea does not seem, by any immediate 
connection, which it might thus have with the 
menses, decidedly to render the uterus unfit for the 
purposes of generation ; since some women slightly 
affected with it bear healthy children ; and others, 
though very much distressed by it, have yet living 
children at the proper period of parturition ; the 
children of the latter, however, so far as my oppor- 
tunities of observation extend, are in general delicate. 

The bad effects of leucorrhoea, on the production 
and nourishment of the foetus, may all depend on 
the general disturbance of the functions of the ute- 
rine system ; and this is corroborated by the fact, 
that this disturbance is not perceptible, till the dis- 
ease is far advanced, which would certainly sooner 
manifest itself, if the vessels, whence flow the men- 
ses, were primarily and chiefly concerned. That 
E2 



68 

it is hot confined to the uterus, is decidedly proved 
by this, that, after pregnancy, when the mouth of 
the uterus is shut, the leucorrhoeal discharge is of- 
ten more copious than before conception 

The celebrated Hoffman, * to whom Dr Cullen 
acknowledged himself much indebted, very con- 
cisely states most of these facts. " This flow does 
not follow any certain rule with regard to time or 
duration ; in some, it is incessant ; in others, it re- 
turns twice or thrice a month; and there are instances 
of it observing, as it were, stated periods. It is 
found to precede, accompany, follow the menstrual 
discharge, or even seems to be substituted for it. 
Women advanced in life, beyond the time of men- 
struation, are not exempt from it ; and it is present 
during the whole time of gestation " 

Now this discharge is often so acrid, as to ex- 
coriate the pudenda and thighs ; and what dread- 
ful consequences should we not have reason to 
expect, if this acrid matter occupied the vessels 
which pour out the menses ? For, even according 
to my opinion of its being an affection, in which 
the mucous membrane is immediately concerned, 
we have no other resourse than to suppose, that 
some of the muciparous glands are still capable of 
preparing and furnishing healthy mucus, which may 
defend the internal surfaces of the uterus and va- 
gina from the action of such a discharge. 

In addition to these general reasons, we have the 
demonstrative evidence of dissection and actual ob- 
servation, that the flow does not always proceed from 
the uterus alone ; and that frequently the internal 
surface both of the uterus and vagina is concerned 
in the production of the discharge ; and sometimes, 
as already shown, those of the vagina alone : where- 
fore it bahnot» in such instances^ be produced by 
the same vessels which in their natural state pour 

* Med. Rat, Syst. t. 4. page 4. c. 16. Thes. Pathol. § 23. 



69 

out the menses. If to this we add, that the purely 
serous discharge is not established, by one well as- 
certained fact, to have proceeded solely from the 
vessels of the uterus, so as to constitute this disease ; 
we must conclude, that such is at most but a rare 
occurrence, and is by no means the affection ge- 
nerally called leucorrhcea. 

I know that attempts have been made to recon- 
cile the contradictory fact and supposition ; the fact, 
that the fluor albus proceeds from the vagina in 
pregnancy, and the supposition of its being poured 
out by the menstrual vesssels 

The vessels, it is said, of the uterus and vagina, 
are connected by very numerous anastomoses ; and 
hence, when the uterus is clo?ed, the serum flows. 
* But this is so absurd an explanation, that it re- 
quires no refutation. This reasoning is somewhat 
anajagous to that, which -more lately suggested an 
absurd enough practice for the cure of amenorrhcea, 
which consisted in applying pressure to the femoral 
vessels, to produce menstruation. Did they not 
perceive, that if nothing more were concerned in 
menstruation than the mere loss of blood, that the 
monthly use of the lancet would obviate all the bad 
effects of suppression ? The use of the lancet even 
for this purpose was recommended by Dr Fother- 
gill ! f 

In Puncan's Commentaries, there is a case relat- 
ed, which shews, that the leucorrhoeal discharge 
sometimes proceeds from the vagina alone, and 
that the catamenia proceed from the interior sur- 
face of the uterus. 

A woman, who had long laboured under prolapsus 
uleri, was at last attacked also by the fluor albus ; 
and it was observed in her, that the menstrual dis- 

* Trnka, Hist. Leuc pars 1, § 15, p. 47. 
f Vid. Med. Obs. and tng. vol. v. p. 180. 
E3 



70 

charge came through the os uteri, but the leucor- 
rhoeal always from the vagina. * 

That both the interior surface of the uterus and 
vagina may be concerned, these, with the following 
facts from Morgagni on the leucorrhoea, will amply 
prove. 

f He squeezed the white matter of fluor albus 
from different parts of the interior surface of the 
uterus. 

% In a virgin, who died at the age of fourteen, 
were found tubercular swellings on different parts 
of the viscera, and a very thickened portion of" the 
omentum adhered to the fundus uteri. The uterus 
was very small. The capacity of the fundus was 
full of a white humid matter, verging to a yellow 
or greenish colour. Minute whitish tubercles ap- 
peared on its anterior surface, but none at the bor- 
der of the os uteri. The vagina and hymen were 
inflamed, from the matter, no doubt, of the dis- 
charge. 

|| In another case, greyish white matter was found 
in the cervix uteri and vagina ; the blood vessels 
of the fundus gave an appearance to the membrane, 
similar to what the schneiderian would evince in 
consequence of cold. And he adds, that both an- 
cient and modern physicians reckoned these effects 
very similar to each other. 

I have, however, no hesitation in stating the va- 
gina to be the common source of the disease. 

We might, with equal plausibility maintain, that the 
puriform matter occassionally discharged from the 
cavities of the lungs, fauces, and nose, is poured 
out by the same vessels with the blood in epistaxis 
and hymoptysis, as that the menstrual and leucor- 
rhoeal discharges proceed from the same vessels. 

* Commentaries, vol. iv, p. 88. 
f Morgagni, EpiM. xlvII. $ 12. 
% Idem, § 14. 
J| Idem, Epist. lxvxi. 

*V1 






■ 



71 

It is of importance to observe, that a great pro- 
portion of women have been taught to believe that 
Jeucorrhoea is a natural discharge, the existence of 
which is, for the most part, absolutely necessary to 
the preservation of health ; and if their health be 
already considerably impaired by it, the old and ex- 
perienced matrons most fatally console themselves 
and others in the supposition, that to this discharge 
alone they owe the little health they possess. It is 
not therefore to be wondered, that women often so 
strenuously deny being affected by it. 



Of the Source of the Leucorrhoeal Discharge. 

As it appears established, that the leucorrhoeal dis- 
charge proceeds from the uterus, and more especially 
from the vagina, or from both, in consequence of 
an affection occupying, to a greater or less extent, 
one, or other of the internal structures of those 
parts, or both of them at the same time ; and that 
discharges, from other sources, or caused by other 
diseases seated in the same parts, may be mistaken 
for the leucorrhoeal ; but we may, by a little attention, 
easily distinguish the latter from the former. 

It may be difficult to determine, whether the 
f discharge proceeds from the vagina alone, or from 
the uterus, or from both. 

When there has been no disturbance in the func- 
tions of the uterus ; when the general health is 
good, or not evidently suffering much ; when the 
functions of the stomach, which so sympathetically 
participates in the morbid affection of the uterus, 
remain unimpaired ; we have reason to think that 
the vagina is chiefly in fault, and vice versa. 

f- 



But if the disease have altogether another source, 
and proceed from the urinary organs, we may dis- 
cover, by the functions of the bladder being dis- 
ordered, by pain in passing water, the discharge 
being much increased in rising from a horizontal 
posture, the appearance of the urine, and the dis- 
charge always disappearing for sometime after the 
passage of the urine. 

When the case is, as very frequently happens, 
rendered complex, by the presence of other affec- 
tions, we must judge of these, as. well as of their 
magnitude and importance, from the additional 
symptoms which manifest themselves. Many facts 
detailed throughout this work will convince any one, 
that the discharge is often only a concomitant symp- 
tom, or comparatively insignificant addition to af- 
fections which may hold in contempt the dexterity 
of art, and almost convert into folly the ingenuity 
of science. 

The two following cases, which lately came un- 
der my observation, as illustrating these varieties, 
are worthy of notice. 

A young girl, aged 16 months, after suffering 
severely from an inflammation in the left groin, 
which rapidly became of a livid color, suppurated, 
burst, and became an ill-conditioned ulcer, was af- 
fected with swelling of the labia pude?idi t and had 
puriform matter discharged both from the ulcer 
and from the parts of generation. The ulcer was 
kept clean, dressed with ung. alb., and cath.rtus 
were given ; but still the ulcer increased in size, 
and became puckered, irregular, and thick in the 
edges. 

On examining the child's mouth, several of the 
teeth were felt distinctly almost through the gums, 
which being freely opened, the child soon after » 
seemed much relieved. The ulcer was still dressed 
as formerly. 






73 

Speedily the ulcer in the groin assumed a healthy 
appearance, the inflammation was greatly reduced, 
and not long after, it was completely healed. The 
state of the teeth was evidently the cause of this 
complaint. 

Another young lady, aged five years, had, for 
several weeks, been affected with violent inflamma- 
tion of the labia pudendi, with great swelling, dif- 
ficulty of voiding urine, and a plentiful discharge of 
puriform matter from the parts of generation. The 
parts became livid and acutely painful, but there 
was no external ulceration. Cathartics were given, 
and emolient poultices were applied, before J saw 
the child. On examining the mouth, I found that 
the child had the full number of teeth for one of 
her age. By a continuance of the treatment men- 
tioned above, the inflammation, swelling, and pain 
in voiding urine, gradually abated, and, in about 
ten days, entirely disappeared. The discharge from 
the parts of generation continued about a week 
more, when it likewise went away. , 

= 

Causes. 

There is not a power that can debilitate the hu- 
man frame, but has been, and perhaps truly, reck- 
oned a cause of this complaint. 

Those circumstances, however, that contribute 
most immediately to its production, are such as 
debilitate the uterus itself, viz. difficult labour, 
abortions, and uterine hemorrhagies ; to which may 
be added, inflammation, and whatever can induce 
subsequent atony of the membranes investing the 
vagina and uterus. 

As to the suppression of the mucus discharged 
from the nose, or even that of the secretion of milk 



-A 



74 . 4 

in the mammae of nurses, which have been num- 
bered among the causes, they seem scarcely worthy 
of notice. 

The disease is denominated leucorrhcea, fluor al- 
bus, or whites, from the appearance of a certain 
fluid matter discharged per vaginam ; which is the 
characteristic symptom of the affection* 

In addition to the discharge, the patient com- 
plains of severe pain of the back and pubis. Pains 
of different degrees of acuteness and continuance, 
also extend along the spine, the loins, and are oc- 
casionally felt in the head, in the stomach, in the 
intestinal canal ; in the kidneys, bladder of urine, 
uterus, and in one or more of the joints. 

The abdomen is tense, hard inequalities are often 
felt in different parts of it; and, lassitude, debility, 
and sluggishness, are generally remarkable. 

The pulse is from 80 to 100, or J 10, per minute; 
feeble, sometimes irregular, or even intermittent. 

The patient is oppressed with a sense of weight 
in the cervix uteri, so that she feels easier when 
sitting with the knees drawn upwards. She sleeps 
but little, and even that little is disturbed by fear- 
ful dreams, and is far from refreshing. 

The general health and external appearance suf- 
fer apace, though near the commencement of the 
disease, and even for a long time of its course, this 
is not very perceptible. 

She generally looks pale and emaciated, her eyes 
are generally dull, and streaked with a dull red, and 
have a blue semicircle under them ; there is a cer- 
tain softness, a sort of puffy swelling and bloated 
appearance over the whole body, in this respect re- 
sembling chlorosis. 

In the progress of the disease, the skin assumes 
a yellow taint ; the feet and ankles swell toward 
evening. Some, or all the functions of the body, 
become less or more disordered, appearing variously 



x Qw *wf£ £ p d t4 Mm <£ : 



I 



*. 









75 

in different individuals, and at different times dur- 
ing the disease. 

Her mind is very dejected, very apprehensive, 
very easily alarmed, and affected with deep melan- 
choly, She is extremely peevish, fretful, irascible, 
and anxious. 

She feels oppressed about the precordia, is trou- 
bled with slight cough, dyspnoea, and pain on full 
inspiration, with palpitation and fainting, particu- 
larly on the body being suddenly moved, or the 
mind in any way alarmed. 

The affections of the stomach and intestinal ca- 
nal are generally present during the whole course 
of this complaint ; these are want of appetite, de- 
praved digestion ; in short, all the symptoms of 
dyspepsia, with sickness in the morning and even- 
ing, and vomiting. 

The bowels, for the most part, are obstinately cos- 
tive, but sometimes there is a severe dy senter ic at- A 
tack, succeeding the constipation. 

The urine is turbid, and the bladder is often 
much affected. 

The menstrual discharge is frequently too copi- 
ous, irregular and discoloured ; sometimes scanty, 
or even suppressed, as shall subsequently be ex- 
plained. 

This last occurrence has been followed by very 
singular symptoms, for to the suppression of men- 
ses, we are assured that there often supervene hae- 
moptysis, dysentery, hoematuria, inflammation, 
schirrus, many affections of the viscera ; and there 
is not only epistaxis, but discharges of blood from 
other parts, as the meatus auditorius, the points of . 

the fingers, &c. -frr^w. 

The disease is sometimes cured spontaneously, 
by some change or revolution in the system, mani- 
festing itself in critical evacuations, as copious sali- 
vation, diarrhoea, sweating, vomiting. / 1 - 



75 

It is said to have been sometimes, though rarely, 
removed by puberty and conception. 

But when it is not removed by nature or art, it 
proceeds to waste the constitution with accumulat- 
ing mischief. All the calamities above detailed are 
aggravated.. The eyelids and face at length swell 
in the morning, the legs and feet in the evening ; 
the body is astonishingly meagre and debilitated, 
and now, in the last stage, hectic fever, with all 
its dire attendants, and dropsy in every form, su- 
pervene, and terminate the miserable scene. 

Hysteria, in a greater of less degree, generally 
precedes and accompanies the disease through its 
course. ' 

The greater number of those symptoms are com- 
mon to this, with the other affections in which the 
uterus is, or appears to be, concerned. 

The. disease is said to have affected females „of 
every age, even infants at birth, and I have known 
it to affect them shortly after, and to continue for 
many years. 

It sometimes attacks severely, during pregnancy, 
those who are slightly affected with it when not in 
that state ; and there are instances of women being 
attacked with it only during pregnancy. 

After it has continued for some lime, the function 
of generation is disturbed, and it is not an uncom- 
mon cause of sterility. 

It has- observed all the varieties of duration, from 
a momentary attack to that of 30 years or more ; 
in general, however, leucorrhcea is very obstinate, 
and not unfrequently defies all the powers of art. 



Discharge. 



The discharge is sometimes continued, some- 
times intermitted ; varies in quantity at different 



77 

times, and according to different circumstances; is 
more copious in winter than in summer, is also 
more copious a day or two before the flow of the 
menses, than during the rest of the interval be- 
tween the period of their appearance. 

But the quantity is occasionally very abundant, 
or the contrary ; being influenced by passions of the 
mind, and every thing that in the least affects the 
state of the body. 

The matter of the discharge assumes a great va- 
riety of appearances, according to the state of the 
parts from which it proceeds, and more or less, 
that of the general habil conjointly. 

It is at one time clear, limpid, viscid, or glairy ; 
at another, white, gre p n, yellow, brown, or of mix- 
ed colours, sometimes it is completely puriform 

When the disease is far advanced, it becomes 
sanious, ichorous, acrid, shockingly disagreeable to 
the sight and smell, and excoriates the uterus, va- 
gina, labia pudendi, and thighs. 

In the discharg-e there sometimes appear, parti- 
cularly in the last stage, fleshy tumours, detached 
coagulated substances, portions of membranes, the 
products of spacelation, and even animalcula resem- 
bling ascarides, are recorded to have been found in 
it. — £V>vor <xa <*£& 

Sometimes the discharge stops spontaneously, 
and this is succeeded by very troublesome conse- 
quences, as pains in the hypogastric region, and 
head, fever and delirium ; ulcers break out on dif- 
ferent parts, which relieve these symptoms ; and, 
not unfrequently, on such an occasion, acute, chro- 
nic, exanthemata, breakout over all the body. Ery- 
sipelatous, and other Options, however, are not 
rait at any time during the disease. 

Dr Cullen's hypothesis implies, that the leucor- 
rhceal is nothing else than the depraved menstrual 
discharge : . But this is not only very improbable, 
from the circumstances above mentioned, but from 



78 



others ; the leucorrhceal discharge has often all the 
appearances and properties of pus; are we therefore 
to suppose that the menstrual fluid ever assumes 
this form ? 



Distinction, &c. 

Some practitioners have deemed it of importance, 
to ascertain, whether the complaint originated from 
venereal affection, and was preceded by local in- 
flammation of the vagina, because, in these circum- 
stances, they would consider it rather as gleet than 
leucorrhcea. 

But between gleet, considered as a disease of de- 
bility, the principal symptom of which is a chronic, 
mild, glairy, or somewhat puriform discharge from 
the vagina, and leucorrhoea as an atonic complaint, 
there really is and can be no distinction, from what- 
ever cause they may have originated ; the medical 
treatment of both must be precisely the same, and 
equally regulated by the same concomitant symp- 
toms. 

It will frequently happen, that we cannot deter- 
mine whether the complaint has arisen from vene- 
real infection, or not ; in most instances, however, 
we may judge with tolerable precision, from certain 
circumstances in the history. 

If the patient has been rather declining in health 
for some time, been troubled with stomachic affec- 
tions, pains in the loins, &c. ; has not been regular 
in her menses, either as ti^quantity, duration, or 
recurrence ; if the menses rave either been preced- 
ed or followed, for some time, by an usually great 
serous discharge ; and there has, to these symp- 
toms, succeeded a thin, glairy, or even more or less 
puriform discharge, unaccompanied with heat or 
pain in the bladder or uterus, or their canals ; if 



79 

the patient has suffered from abortions, tedious or 
difficult labours, or is at that age when the men- 
struation must cease, in obedience to an immutable 
law in the animal economy, we sh#ll be pretty safe 
in considering the complaint as a leucorrhcea. 

But if a woman, enjoying good health, is sud- 
denly attacked with ardor urinae, puriform discharge 
from the vagina, and other inflammatory symp- 
toms, the suspicion of venereal infection will be ve- 
ry strong. 

Still, however, let us hesitate before we pro- 
nounce an opinion ; we may stain the purity of in- 
nocence, and, to bodily sufferings, add those of the 
mind, from which the unfortunate individual may 
never recover rf- ^U J 

Though the suspicion be very strong, yet even 
this form of the disease may arise from many cau- 
ses, totally independent both of infection or coi- 
tion. 

Inflammation of the most active kind, seizes the 
female organs of urine and generation, quite inde- 
pendently of infection, and that even in infancy, 
as is shown by the two cases, page 72., when the 
time of life precludes the possibility of suspicion ; 
there is no accoucheur who cannot testify this. X 

Youno- women are sometimes afflicted with such 
itchings, heat, and pain, in these parts, that they 
can neither sleep, sit, nor walk. 

The glands about the urethra, the clitoris, the 
labia pudendi, are discovered to be enormously tu- 
mified, reddened, excoriated, and exquisitely sen- 
sible to the touch. Pus flows in great quantity ; 
the urine cannot be voided without excruciating 
torture; and the complaint is completely remove- 
able by the common antiphlogistic means. 

In short, the membranes investing the vagina 
and uterus may be inflamed, though not by the 
poison of lues, just as easily as those investing the 
mouth, fauces, and lungs. 

J / • / 



80 

When the discharge has continued for any great 
length of time, the constitutional and local symp- 
toms are the same, from whatever causes the di- 
sease has proceeded ; and the cure is to be con- 
ducted in precisely the same way, so that the dis- 
tinction is not now of so great practical impor- 
tance ; but even here we sometimes form a pretty 
correct opinion, from enquiring into the history of 
the complaint. 

Even though a gonorrhoeal discharge, with or 
without excoriations of the prepuce and glans pe- 
nis, appear in consequence of connection with a fe- 
male, this is not complete evidence of venereal in- 
fection ; for this often happens to a husband, when 
his wife labours under leucorrhcea 

We have reason to believe, that, on such occa- 
sions, the rash and false judgment of medical men, 
has often been productive of irreparable mischief, 
blasting the reputation of an innocent wife, the con- 
fidence and peace of mind, both of her and her 
husband, and disgracing their innocent offspring* 



Affections combined with Leucorrhcea. 

There is not a disease which assails the female 
body, with which, according to authors, leucor- 
rhcea has not been connected in the relation of 
cause, concomitant, or effect. 

The affections, however, with which it is most 
frequently connected, are those of the uterus and 
its appendages; and among these we may number 
schirrus, cancer, tumours of various descriptions, 
indurations, and other affections of the vagina^ ute- 
rus, and ovaria; similar affections also of the blad- 
der and kidneys, paralysis of these parts, strangury, 
er dysury, and calculous affections. 

It often exists along with scirrhus, or cancerous 



81 

tumors of the mammae, and with some one of the 
herniae. In short, whatever greatly deranges, and 
greatly debilitates the system, is most apt to occa- 
sion it. 

In examining cases of this disease, we ought to 
ascertain whether there are tumors about the cer- X„ 
vix uteri, or any of the parts tnatcan be examined. 

In females advanced in life, and particularly a- 
bout the time of the cessation of the menses ; and 
in those who have cancerous affections of the mam- 
mas, we have occasionally reason to think that such 
tumors are present, from small fleshy bodies having 
been voided per vaginam. 

When, without the evident symptoms of disor- 
der in the uterine functions, there has been great 
pain and irritation in the parts, unaccompanied by 
any discharge, with some other inflammatory symp- 
toms, more or less severe, and these at last abate, 
and a discharge of puriform matter appears, we have 
reason to think that an abscess has been formed. 

The following cases, treated by Mr Hey of 
Leeds, do great honour to the author. 

*■" In April i780, Mrs D. of S. about 20 miles 
From Leeds, consulted me on account of a very 
troublesome fluor albus, as she judged it to be. 
She informed me, that the disorder had come upon 
her about five years before, during pregnancy, and 
had hitherto resisted the effect of every remedy 
given for * her relief. In answer to my enquiries, 
she gave me the following account of her complaint. 

" The colour of the discharge was white, inclining 
to yellow. It flowed in an irregular manner, un- 
connected with any circumstance which she could 
recollect. Sometimes it began to flow suddenly in 
large quantity, and continued diminishing until it 
ceased. The parts were often rendered sore by the 
evacuation. 

" From these circumstances, I suspected that the 
nature of the complaint had been mistaken, and 

* Hey's Surgery, 1303. p. 486. 



h 



82 

was apprehensive, that a collection of purulent mat- 
ter might have been formed in the vagina. I gave 
her the reasons of my suspicion, and told her, that, 
in my opinion, the true state of her case could not 
be ascertained, without an examination of the parts 
affected. 

" Upon examination, my suspicions were verified. 
I found a quantity of purulent matter collected on 
the left side, where the labium pudendi joins the 
vagina. I thrust the blunt end of a probe into the 
cyst, where it appeared to be very thin, and the 
matter flowed out very copiously. I informed her, 
that a surgical operation would be necessary for her 
cure ; but she declined submitting to it, and return- 
ed home. 

" I heard no more of my patient till May 1781, 
when she returned to Leeds, determined to put her- 
self under my care. The disorder had remained in 
the same state. The cyst was sometimes healed, 
and then bursting open, continued for a time to 
discharge the purulent matter as before. 

" Upon dividing the cyst, I found that the cavity 
in which the matter lodged, was about an inch and 
a half in diameter. The whole interior surface of 
the cyst was smooth and shining ; and, on that ac- 
count, I judged it improbable that a simple divi- 
sion of the cyst would effect a cure. I thought it 
necessary, therefore, to remove the greater part of 
that portion of the cyst, which was formed by the 
internal lining or cuticle of the labium pudendi. 
The hemorrhage was inconsiderable, and soon 
ceased. The wound healed kindly, • and my patient 
obtained a perfect cure." 

" In 1786, Anne Miller came under my care as 
an out patient of the General Infirmary at Leeds, 
for a node upon the tibia, which I suspected to have 
had a venereal origin. When she was about to be 
discharged, cured, she informed me, that she had 
been troubled for 1,5 or 16 years with sudden and 



&A Cfc/J </ 






■ 



83 • 

irregular discharges of purulent matter from the 
vagina. These discharges, she said, were frequent, 
and considerable ; yet she never perceived any mat- 
ter to be mixed with her urine. 

" Upon examination, I found a roundish tumor at 
the os externum, appearing to be formed by an 
enlargement of the bulbous part of the urethra. 
When the tumor was compressed, pure pus issued 
from the urethra; yet her urine did not contain 
the least mixture of purulent matter. Upon intro- 
ducing a bent probe into the urethra, I could easily 
push it into the most depending part of the tumor; 
and could feel the probe distinctly by a finger in- 
troduced within the vagina. 

" I divided the tumor longitudinally, at a time 
when it was distended with matter. That part of 
the vagina which I cut through, was not thinned by 
distention, but was rather tough. The cavity of 
the cyst was smooth. As the opening which I 
made was depending, and as the removal of any 
part of the cyst would have been attended with 
difficulty, I only filled the cavity with lint. A 
small artery was opened by dividing the cyst, but 
the hemorrhage did not continue long. This pa- 
tient recovered speedily, and got quite free from 
the complaint." 

When cancer is present, the symptoms are too 
tremendous, and too decisive, to leave any room 
for doubt. 



OF CHLOROSIS. 



The disease, termed Chlorosis or Amenorrhcea, 
is caused either by a suppression or by a retention 
f 2 



. 84 

menstruation ; not appearing at the usual period, it 
is the cause of great distress. 

The features are, in this disease, tumified and 
inexpressive, and a paleness or yellowness, nearly 
approaching to a shade of very faint green, pervades 
the whole of it, while the eyes are dull and heavy. 
The body is flaccid, and the extremities are edem- 
atous ; weariness and pains are felt about the loins ; 
and the patient is totally unable to use the most 
moderate exercise without suffering the greatest 
distress. 



..... 
OF DYSMENNORRHCBA. „^o 

' Whatever may have been the original cause of 
what is called Dysmenorrhcea, in which the cata- 
menia flow with difficulty, and are accompanied 
with great pain, we know debility to be in general 
present to a great degee when that disease is vio- 
lent. 

Cullen, as usual, thinksi, that it depends on spasm 
of the extreme vessels ot the uterus ; perhaps this 
may exist along with it, but I am sure that this is 
not the cause of it ; nor do I think his practice of 
prescribing opiates, though it remove such spasm, 
can possibly remove the disease. Hyociamus has 
been prescribed, which acts nearly on the same 
principle. 



OF MENORRHAGIA. 



Menorrhagia is ah irregular, but at all times an 
increased flow of blood from the parts of the ge- 



85 



neration of women, or it may simply consist in a 
remarkable increase of the menstrual fluid alone. 
But from whatever cause it arise, (for various causes 
may combine to produce this state) it uniformly 
tends to induce every symptom often of the most 
dangerous debility of the general system. 

All the causes of menorrhagia, assigned by Cullen 
in his first lines, such as a continuance of full and nou- 
rishing diet, much strong liquor, intoxication, vio- 
lent shocks of the whole body from falls, or con- 
tusions on the lower belly, violent exercise, violent 
passions of the mind, excess in venery, particularly 
during menstruation, a Costive habit, &c. ; fre- 
quent abortions, frequent child-bearing without nurs- 
ing, difficult tedious labours, living much in warm 
chambers, and drinking much warm enervating li- 
quors, such as tea, &c, are evidently calculated to 
induce, directly or indirectly, a state of local or 
general debility, previous to the appearance of the 
disease ; consequently I cannot with him consider 
it as an active hemorrhage. 

In advanced stages of these complaints, the most 
depressing debility is experienced on the very slight- 
est exercise being used ; and even this takes place 
without motion, while the pulse is uniformly feeble 
and irregular. 



While enumerating these diseases, I may take 
notice of another complaint, which, in a practical 
point of view, resembles those I have just mention- 
ed. I allude to that distressing irregularity in men- 
struation which very commonly torments the patient 
for years, but more frequently only a few months 
previous to the complete dissappearance of the cat- 
amenia. 

We sometimes also meet with cases where the 
menstrual flux, after having continued regularly for 

*3 



86 

Some time, begins, by gradual steps, to became ir- 
regular, and, at length, a total suppression takes 
place. This state of the system often continues for 
months, or, in very strong women, even for several 
years, without occasioning any apparent injury to 
the general health. But, unless it be removed, 
the complaint always terminates in an almost 
complete wreck of the constitution, and, often, 
when all the very worst symptoms have accumulat- 
ed, there is added to them occasional irregular 
floodings, attended with most excruciating pain. 
Under these circumstances, if the patient be not 
soon relieved, she is generally seized with some 
other systematic affection which almost always ter- 
minates her existence. 

I have seen numerous cases of this sort, and am 
convinced that every moment lost, till the patient's 
complaints are removed, is, though often for years 
unperceived, ultimately attended with certain ruin 
to the constitution. 

It is by no means an uncommon symptom, at- 
tending irregularity in the menstrual discharge, for 
an enlargement of the uterus gradually to take place, 
similar to and not uncommonly, under certain 
circumstances, mistaken for] pregnancy. I have 
known many ladies persist, from this enlargement, 
as well as from a similar motion to what is felt in 
pregnancy, in the notion of their having been 
in that state for several months Disappointment, 
however, was always the result j for, either without 
any visible cause, or even the slightest discharge, 
or, occasionally, with a copious discharge of dark 
coloured fluid, the enlargement has in a few hours, 
often sooner, entirely dissappeared. 



87 

CHAP. IV. 
GONORRHOEA. 



Introductory Remarks. 



Decided parties of theorists have always existed, 
each endeavouring to defend his peculiar notions 
respecting the nature of the veneral poison. Some 
insist upon the nature and properties of the matter 
of gonorrhoea and lues venerea being entirely dif- 
ferent from each other. Some that these fluids are 
of the same nature, but equally capable of produ- 
cing either of tihtese diseases, according to the ana- 
tomical structure of the parts to which the matter 
of infection is applied; others, that either of these 
kinds of matter can produce the same or the oppo- 
site affection in a sound person, and not on the per- 
son who Secretes them, according to the nature, 
susceptiblity, or structure of the surface to which 
the infecting matter is applied ; while some maintain 
that these effects are greatly modified from the pe- 
culiarity of habit of body of the person to whom 
the infecting matter is applied, or according to the 
virulence of the matter itself, — a gonorrhoea being 
in general produced by a midler cause, and in a 
shorter period, than lues ; and this last argument is 
attempted to be supported, when these complaints 
appear in the same . person, by the gonorrhoea ap- 
pearing first, chancre next, and so on. 

I confess I have, at various periods of my life, 
been sometimes inclined to the one, and sometimes 
f 4 



88 

to the other side of the question. Practically con- 
sidered, however, we all know that these affections 
are in general removeable by plans particularly ad- 
dapted for each. Gonorrhoea yields to injections, 
which, if applied to chancre, produce no beneficial 
effect ; and, on the other hand, lues iscured by the 
various modes of introducing mercury into the sys- 
tem ; but in perhaps no well marked case of gon- 
orrhoea will this substance, similarly applied, remove 
it. There may be some exceptions to these ru!es A 
but in general they hold just, and when such ex- 
ceptions do occur, much must depend on the dis- 
cernment of the medical attendant, in rationally con- 
sidering them. Bigotted opinions in the medical pro- 
fession may often lead to very serious consequences 
for the patient ; they ought, therefore, not to exist. 

The arguments in favour of all these opinions 
above mentioned, seem often judicious and ex- 
tremely plausible ; but neither of their supporters 
have yet been able positively to do any more than 
merely to contradict the assertions advanced by the 
one he wishes to condemn, in order that his notions 
may gain ground. The contest, therefore, seems 
in some points well supported by the ingenuity of 
either set of theorists. 

Owing to the circumstances I have stated above, 
I decline espousing indiscriminately the doctrines 
either of the one or of the other, conceiving it more 
to the point, to dwell on and impress the mind of 
my readers with facts, which can be more clearly de- 
monstrated, and more immediately applied to usjg. v 
Employing time, which is too commonly done both 
in books and in lectures, in discussions which are' 
not only not useful, but often calculated to bewilder 
the mind, and lead to erroneous practice, is at all 
times at least improper. 



Definition. 

Gonorrhcea is a local inflammatory disease, af- 
fecting the organs of generation,' accompanied with 
a discharge from these organs, and not unfrequently 
extending its influence to the whole system. This 
discharge, while the inflammation is yet active, as- 
sumes the form of pus, though it is to be remark- 
ed, that matter discharged from wounded surfaces, 
in the highest degree of inflammation, is often thin 
and watery, holding some acrid saline bodies in solu- 
tion, similar to the discharge produced in conse- 
quence f vesication. Frequently the inflammatory 
symptoms abate, and even gradually disappear. 
When the complaint is not cured spontaneously, 
or by art, the discharge continues, is changed into 
a thin watery fluid, at first whitish and opaque, after- 
wards transparent, mucous, and glairy, and the pa- 
tient suffers from local and general debility. 

Causes, &c. 

Gonorrhoea is excited by a specific contagion, 
and by other causes ; and that form of it which de- 
pends upon specific contagion, is, by immediate 
contact, capable of producing a similar disease in 
the same parts, to a person previously sound. 

I have not facts enough to warrant me to assert, 
how far gonorrhoea, from any cause, except impure 
connection, is capable of being communicated to a 
sound person. But, so far as my observation goes, 
it is not in this case so infectious ; indeed, I have 
not even a well authenticated instance where such 
an occurrence has taken place. Where the matter 
of gleet, too, has been brought, by internal medi- 
cines, to a state similar to that of gonorrhceal mat- 
ter, I have not yet found, that it has communicated 



90 

infection to a sound person. Perhaps others may 
be better able to clear up this matter than I am at 
present ; or perhaps I myself may be better able to 
do it at some future period. 

This disease seems different in its severity, in 
different individuals, but in all is capable of sup- 
porting itself, after the cause which seemingly first 
induced it has ceased to act. When it arises from 
any other external application, or from internal me r 
dicines, its continuance is of much shorter dura- 
tion, as whenever by them a similar discharge is 
produced, it does not in any instance seem capable 
of supporting itself, for any great length of time, 
by any peculiarity of action which the parts from 
such causes assume. 

Seat. 

It may be difficult at any one time to ascertain the 
exact extent of the urethra, that may be affected in go- 
norrhoea. Although we may sometimes be guided by 
the seat of the pain, which is usually most severe in one 
particular spot, yet this is an uncertain method; as we 
know that acute pain may sometimes occur in that 
canal, although the disease, to which it owes its 
origin, is in a very different part. In stone in the 
bladder, for instance, the most acute pain is often 
felt at the orifice of the urethra. 

In most instances, it has been alleged, that the 
seat of this disease is but a short distance from the 
orifice of the urethra. The exact spot, however, 
which may be affected by this disease, unless in- 
deed it extends backwards so as to affect the blad- 
der, &c. is, in a practical point of view, of no very 
great importance. Our injections, in perhaps every 
case, are always thrown a few inches into, the ure- 
thra, and it is seldom, I believe, that the disease 
exists beyond this. 



91 



Symptoms and Extent of the Urethra aeffcted. 

I conceive it totally impossible, in this disease, 
to lay down rules respecting the time which inter- 
venes between the application of the infection and 
its appearance, and equally so to ascertain the pro- 
bable time that may elapse between the time at 
•which this disease may occur, and its removal, even 
under the most prudent management. These cir- 
cumstances, all other points being strictly attended 
to, must be greatly influenced by the habit of body, 
or the constitution of the patient. 

I may remark, that, in some instances.,, the infec- 
tion will sometimes remain many wpeKs in the sys- 
tem without producing discharge.- Thus, a gentle- 
man who was scrofulous, had a number of chancres 
about the glands, and one directly intersecting the 
fraenum ; these did not heal in less than eleven 
weeks ; they had scarcely received a thin pellicle 
for a covering, when a severe gonorrhoea, with 
choi dee, attacked him. I could rely on the veracity 
of the gentleman, who assured me, that he had not 
exposed himself to any fresh infection : I examined 
the penis, and such was the state of the recently 
skinned chancre on the fraenum, that he could not 
have had illicit connection without tearing it. 
Such accidental occurrences are the grand instruc- 
tors of mankind ; in neglecting them, we often 
lose very valuable lessons. Nature teaches by ex- 
ample, not by precept. 

The time then at which this disease appears, after 
exposure to infection, as well as the severity of its 
symptons, are as much different in different individ- 
uals, as if it were entirely a different disease with 
which they were affected. In some, indeed, in 
three, four, or five days ; while in others, six, eight, 
or even ten weeks elapse before any discharge takes 
place. 



92 

In this, as perhaps in every other complaint, a 
general description of the more commonly occurring 
symptoms may be given, and, in the generality of 
individuals, scarcely a diviation from such a dis- 
cription will occur. Yet various circumstances, 
such as the frequent recurrence of the complaint, 
manner of living, &c, will greatly contribute to 
render the symptoms both more regular, or other- 
wise, and more violent or more mild, and will con- 
sequently require the disease to be considered with 
due attention to these circumstances, that we may 
be most successful in our treatment 

After the infection has been caught, the penis, 
in general, becomes somewhat enlarged in all its 
demensions, the glans is irritable, and the lips of the 
urethra become slightly inflamed, and somewhat 
thickened ; the stream of urine is in some degree 
contracted or twisted, and sometimes the small 
glands along the urethra are enlarged, and a chordee, 
with soreness, are felt along the whole canal. In 
some cases all these appearances are observed be- 
fore the discharge comes on ; but more commonly 
the discharge occurs earlv, and accompanies their 
formation. 

The discharge, on its first appearance, is rather 
of a thin and sometimes mixed nature, but this, 
as it advances in severity, becomes thicker in con- 
sistence, and of a greenish yellow colour. This is 
soon succeeded by a greater or less degree of scald- 
ing, and sometimes a sensation of fullness along 
the urethra. The extent of both these symp- 
toms, however, depends more on the particular 
state of the patient's system, than on any quality 
exclusively connected with the disease itself. This 
is about the period when chordee becomes most 
violent. 

The pain increases rapidly after it has commen- 
ced, and the urine, in passing along the urethra, 
seems as if actually scalding the passage. The pa- 



93 

tient is positively in terror at the thought of passing 
it, and the distortion of body which he sometimes 
exhibits in the acts, as well as the convulsed state 
of the muscles of his face, render him an object, 
were it from any other cause, of real pity. 

This distressing heat and pain, during the act of 
passing urine, is owing to the inflammed state of 
the membrane of the urethra ; and this of course 
• is more or less severe, according to the degree of 
disease into which the membrane has been reduced. 
This sensation not uncommonly extends as far back 
as the neck of the bladder, often Causing a com- 
plete suppression of the discharge, and rendering 
the patient's situation extremely uncomfortable. The 
continual desire also to pass water, which such a 
state almost always occasions, from his inability ei- 
ther to sit or walk, all of which he does with the 
very greatest difficulty occasion much real distress. 

Sometimes, then, when the inflammation is at a 
very great height, the gla|fns immediately beneath 
the membrane of the urethra are rendered com- 
pletely incapable of secreting, and consequently the 
discharge is even checked by this very increased 
degree of inflammation. In severe inflammation 
of the membrane, of the nose, and trachia, we find 
the same phenomena occur, and our first sign of 
this violent degree of action beginning to abate, is 
the return of the suppressed discharge. 

It has uniformly been asserted, that the longer 
the pain and discharge of gonorrhoea continue, the 
further the disease advances along the urethra, till it 
even, as has been also asserted by some, reaches the 
bladder, &c. Now, to ascertain the progress the 
disease makes along the urethra, we are desired by 
Mr B. Bell and others, to apply pressure to various 
parts of the penis, and observe, whether by these 
means matter in increased quantity proceeds from the 
orifice. But it seems to me, that all the benefit that 
can be derived from ascertaining the exact spot 



7 



94 

from which the matter flows, is comparatively of 
little importance, to the chances of, by such pres- 
sure, protracting the disease, and perhaps, in a great 
proportion of cases, inducing gleet. 

As the irritation thus spreads on the membrane, 
the discharge increases, and the pain is aggravated. 
Involuntary erections more lasting than those natural- 
ly produced, are excited, and the penis, during them, 
from extraordinary distention, feels as if some com- 
pressing power was applied to the sides of it, or rather 
round its whole circumference. But although pains 
of various acuteness affect the penis, scrotum, and 
and other adjoining parts, often from the commence- 
ment of the disease, none of them are ever so severe, 
as the affection known by the name of chordee. 
While the former pains are of a dull, gnawing, and 
exceedingly distressing nature, the latter are often 
so indescribably acute, as almost to occasion tem- 
porary frenzy. 

Chordee. 

Chordee must certainly depend on the inflam- 
mation, to which gonorrhoea gave rise, having 
penetrated to a considerable depth beneath the 
membrane of the urethra. The corpus spongio- 
sum urethra is affected with the inflammation, as 
well as the corpora cavernosa penis ; the circulation 
is impeded in them, and their powers of extension 
are in some degree restricted. In this state these 
bodies cannot bear distension without occasioning 
great pain. Thus they are inflamed, tumid and 
overloaded, and during erection, laceration of the 

tjcular substance, by which hemorrhagy ensues, is 
r by no means uncommon, and by it immediate, 
/ though generally only temporary, relief is obtained. 
/ Perhaps then this is the most troublesome symp- 
tom connected with gonorrhoea, and it takes its 



»% /H 



95 

name from the penis being curved downward, and 
the glans drawn in as it were with a chord. This 
symptom is most generally felt when the inflamma- 
tion runs high, and is much more troublesome dur- 
ing the first gonorrhoea than in any after affection 
of this sort in the same parts, y, It is chiefly felt 
while the patient is warm in bed, and while the 
penis is in a state of erection. Thus, whenever 
chordee becomes a symptom of gonorrhoea, rest is 
disturbed ; the gonorrhoea! symptoms are aggravat- 
ed ; and the disease is protracted. 

Chordee begins with a spasmodic action on the frae- 
num, during erection. The fraenum thus kept upon 
a constant stretch, has in some instances given way, 
and a hemorrhage which, as just stated, gave tem- 
porary ease to the pain formerly felt along the ure- 
thra, has followed. The discharge, however, soon 
increases, and the symptoms become still more acute 
than formerly. The heat attending the passing of 
urine becomes intense, and it is now attended with a 
heavy and uneasy sensation about the neck of the blad- 
der ; and the accelerators urince, partaking of the 
general tenderness, prevent the patient from sitting 
without the greatest uneasiness aud even pain. In 
this state of the complaint the glands in the urethra, 
from having become considerably enlarged, may be 
felt externally. In this very high inflammatory 
stage of the complaint, and from the enlargement 
of the glands now alluded to, the urine is often pas- 
sed in a small irregular or forked stream, giving rise 
to the supposition of the existence of stricture. If, 
even in this virulent state of the disease, the discharge 
continues profuse, it is a favourable symptom. But 
if, under these circumstances, it stops suddenly, 
other and worse symptoms will ensue, such as swel- 
led testicle, &c, and even the prostate gland and 
seminal vessels have been supposed to suffer from 
this cause. 



96 



Phymosis, SCc. 

JPhymosis, as well as paraphimosis, certainly hav£ 
existed during gonorrhoea, independently of chan- 
cres, but they are more commonly found accompa- 
nying chancres. 

Swelled Testicle, 

Although at any period of gonorrhoea, owing to 
various causes, a swelling of the testicle is apt to 
occur, yet it is most common in the latter stage of 
that disease. 

When the pain is first felt in the testicle, and when 
the epidydimis begins to swell, the discharge from 
the urethra usually abates or entirely ceases, and 
the inflammation in the testicle proceeds. A most 
, exquisitely sensible pain is felt in the epididimus, 
particularly orTlts being touched, and it becomes 
hard. In some patients, the testicle does not be- 
gin to swell till after the epididimus has become 
enlarged. The most exquisite pain is now felt even 
when the testicle is at perfect rest, which is pro- 
bably owing to the distention of its coat. Although 
the scrotum seems enlarged upon the swelling of 
these bodies, yet it but seldom partakes of any great 
degree of active inflammation. 

After the swelling of the testicle, the spermatic 
chord not unfrequently becomes similarly affected, 
and is, as when the testicle is affected, attended with 
very great pain. The whole course of the chord 
is sometimes morbidly affected, and even pain is 
felt in the loins and about the region of the kid- 
neys. The patient is at length distressed with a 
continual gnawing pain in his back> and febrile 
symptoms affect him. 



97 
i 

This symptom, then, is a very frequent attendant 
on gonorrhoea, particularly if, during that affection, 
severe bodily exercise, irregularity of living, or ex- 
cess of venery, have been indulged in, too strong and 
irritating injections used, or the too liberal appli- 
cation of the bougie. It is not so common for 
both testicles to swell at once, as for one to be first 
affected, and, when it begins to recover, we often 
observe the other begin to swell, and, in this way, 
unless under proper management, the disease is of- 
ten protracted for several weeks. 

A little attention may, on almost every occasion, 
prevent the occurrence of this symptom. Indeed, 
that it ever occurs, is perhaps more owing to inat- 
tention or bad treatment, thaff to the nature of the 
disease. 

On the first approach of a swelled testicle, the 
patient feels, as if the one affected was from time 
to time in a state of slight motion. But this 
soon gives place to dull, heavy, burdensome pain, 
to which is soon added twitching, darting pains ; 
it gradually, sometimes quickly, increases in size, 
and a throbbing sensation is felt in it, so that sus- 
pension of it becomes necessary. 

This symptom, however, unless from improper 
treatment, seldom remains. But when the dis- 
charge entirely ceases before the swelled testicle 
has subsided, the swelling remains often for years, 
and sometimes for life. Permanent swelling of the 
testicles is, on the contrary, more apt to be induced 
by causes (such as external violence, &c.) which do 
not occasion a discharge from the urethra; and these 
swellings very frequently continue for life. 

The testicles, too, often become enlarged and har- 
dened, and remain in that state for many years, 
without occasioning much in convenience to the pa- 
tient : At other times, they become first somewhat 
enlarged in size, but, almost immediately after, ona 

G 



Q8 

or both of them evidently decrease greatly below 
their natural size, and at length entirely disappear. 

Affection «J the Prostate Gland. 

Probably the surest way to ascertain, whether 
or not the prostate gland be diseased, is by examin- 
ation, on introducing the finger per ano; if so, it 
will feel larger than natural, and painful to the touch. 
Other less symptoms may sometimes direct us in 
ascertaining the state of this gland, such as a dull 
heavy pain in its situation, an occasional shooting 
pain along the rectum, and frequent attempts to 
void urine without the ability to do it. These latter 
symptoms, however, may depend on other causes, 
and consequently cannot be admitted as dignostic 
signs of the existence of this complaint. 

When the prostate gland is diseased, it is pro- 
ductive of very distressing symptoms. It may be 
generally inflamed from the effects of gonorrhoea, 
or it may arise from a scrofulous state of the system ; 
from long and excessive drinking, or from very long 
and frequent venereal indulgences. If it arises from 
venereal indulgences, provided it be early attended 
to, and the cause withdrawn, if no constitutional 
cause assists in supporting it, the healthy functions of 
the gland will be easily restored. Even when this 
disease arises from a constitutional cause, it gene- 
rally comes on late in life, and even then, the excit- 
ing cause of it generally is, either together or se- 
parately, excessive venery, or hard drinking. 

When the gland is affected, there is a thick white 
discharge of mucus passed at irregular periods from 
the urethra. This has a faintly nauseous smell, and 
may be perceived by those who sit in company with 
the patient. This discharge increasing in quantity, 
the patient becomes pale, emaciated, and dejected, 
and becoming gradually weaker, he at length is 
exhausted, and dies 



99 



Ophthalmia. 

1 think there can be no question that the vene- 
real ophthalmia, during both gonorrhoea and pox, 
is, in every instance, produced from a direct appli- 
cation of the matter to the eyes ; not from a retro- 
pulsion of the disease, as has been ridiculously assert- 
ed. Patients are too often careless of these matters. 
They ought at all times, immediately after touching 
the affected parts, to wash their hands with soap 
and water. 

This attendant on the disease, is one ot the most 
acute, inflammatory, painful, and destru< tive affec- 
tions, which perhaps occurs in the whole r;.nge, 
either of the practice of physic or surgery. In 
comparing it with the whole class of acute diseases, 
indeed, there is none equal to it, in rapidity, torture, 
and destruction. 

Concluding Observations. 

The violence of gonorrhoea is greatly influenced 
by the climate, age, sex, peculiarity of constitution, 
manner of living, habits, &c Its violence, I should 
imagine, is more to be attributed to one or other 
of these causes, than to any peculiarity exclusively 
incident to the disease itself. * 

In some we find the discharge small in quantity^ 
attended only by slight pain, while in others, the 
discharge is copious, and the pain and chordee most 
excruciating. These various circumstances, how- 
ever, do not seem of themselves, in any remarkable 
manner, to influence the duration of the com- 
plaint. In some, a small discharge will be easily 
removed in one, two, or three days; in ot; ers it 
will, independently of our every exertion, remain 
for several weeks; In cases, too, where the dis- 
G2 



100 

charge happens to be excessively plentiful, we find 
the same uncertainty attend its removal. 

In Women. 

Gonorrhoea in women, is rarely attended with 
symptoms of such violence as the same disease in 
men. This circumstance can only be accounted 
for from the simpler construction of their genera- 
tive parts. Indeed, so mild is this disease in fe- 
males, that they are often affected by it without be- 
ing conscious of it. 

It has, therefore, been generally observed, that 
women affected with this disease, suffer not from 
pain so much as men generally do. This, however, 
must be in some measure attributed to its more fre- 
quently affecting the vagina than the urethra. In- 
deed, I believe, in almost every case of gonorrhoea 
among women, the vagina alone is affected. Even 
then, however, this disease, by neglect, or other 
causes, creates much distress by the inflammation 
which it occasions in the nymphae, clitoris, &c. ; 
from this case alone, the patient is often unable 
either to sit or walk. This we find, that although 
the symptoms of a gonorrhoea in women are mild, 
yet we also find, in some cases, that an inflammation 
along the vigina, swelling of the labia, nymphas, 
clitoris, carunculae myrtiformes, with excoriations 
about the perinaeum, and meatus urinarius, are not 
uncommon. This aggravated state of the com- 
plaint, is of course attended with pain, itching, 
scalding of urine, excessive discharge, uneasiness 
in sitting and walking ; and the enlarged labia, from 
the inflammatory action accompanying this state, 
makes it protrude considerably. 

Sometimes the inflammatory symptoms are not 
even confined to these parts, as we find them, al- 
though not very frequently, extend over the lower 
part of the abdomen, so as even to cause consider- 



101 

able pain from the slightest friction or pressure. 
When the inflammation has continued long and 
violently, the glands within the labia often became 
enlarged, and even although the gonorrhoea be re- 
moved, they never return to their original size, and 
not unfrequently they even suppurate. 

Consequences. 

It is by no means an uncommon occurrence for 
a patient, under certain circumstances, to have a 
return of all his gonorrhceal symptoms, even at the 
distance of two or three weeks after the discharge 
had entirely disappeared. Any thing taken inter- 
nally that may irritate the body in general, will re- 
produce it, particularly ardent spirits, however much 
diluted; medicines of any other kind that may ir- 
ritate the parts in particular ; much walking, run- 
ning, fatigue of any kind, and above all, riding much 
on horseback. 

When this disease has been nearly removed, it 
usually at that period abates, even in its virulence ; 
and that so remarkably, that a person, frequently 
in the habit of having connection with such a wo- 
man, will not receive infection, while one, less ac- 
customed to cohabit with her, will almost to a cer- 
tainty be affected. 

When the violent inflammatory action has sub- 
sided, there often remains ardor urinae, felt in a 
particular part of the urethra ; and the discharge, 
after having been acrid, yellow, green, tinged with 
red, or even mixed with blood, at last assumes the 
thick, opaque, white, bland qualities of pus from a 
healthy granulating sore. 

At this time, the severity of the antiphlogistic 
treatment must be relaxed, and generally mild injec- 
tions alone will most speedily complete the cure, or 
the constitution even unassisted will return to health. 

I have found, that scrofulous habits, on the first 

q a 



102 



attack of the gonorrhoea, are remarkable for the du- 
ration of the inflammation, and the quantity of the 
matter discharged This inflammation and dis- 
charge soon yield to sedative means ; but the dis- 
charge is renewed with uncommon facility, and such 
persons are very obnoxious to gleet. 

In such cases, the most active internal and ex- 
ternal applications are requisite for the cure. 

We shall not be surprised that such active means 
are required, when we consider the general disor- 
der that is prevalent in scrofula in the solids, both 
muscular and bony ; nor do I see any reason to ex- 
empt the fluids from the general depravity. 



103 



OF LUES VENEREA. 



Definition, General Observations, &c. 

Lues Venerea, or Syphilis, is a disease principally 
of the absorbent system, but soon affecting all the 
vital functions, and generally arising from impure 
connection. 

It has generally been understood, that this dis- 
ease may be introduced into the system in two 
ways ; either in the natural and most common way, 
through the medium of the absorbent vessels, or by 
transplanting a tooth of one venereally affected 
into a sound person. Tn the first, it is necessa- 
ry that the virus should pass through the absor- 
bent vesselsinto the blood ; in the latter, the absor- 
bent vessels are less necessary to the virus, being 
applied to the blood. In the former, the disease is 
generally slow in its progress, but in the latter it is 
rapid and violent. 

The infecting matter of lues venerea, cannot act 
through the medium of the air, but through the 
medium of a fluid. Besides, it cannot be commu- 
nicated, but by immediate contact of a sound with 
a diseased person ; and although, for the most 
evident reasons, it commonly appears on the ge- 
nitals, particularly on the delicate surface of the 
glans penis, &c. the same virus is capable of oc- 
casioning morbid appearances on any other organ 
of the body. 

Woman is as much exposed as man to venereal 
infection ; but, from the different structure of the 
G 4 



104 

parts, the symptoms are in her scarcely ever attend- 
ed by such violent effects. This has, in some mea- 
sure, been attributed to the simplicity of structure 
of the female organs of generation ; but I am of 
opinion, that this arises more commonly from the 
the natural flow of fluids to these parts, in the fe- 
male washing off the infecting matter 

It may be received as a general rule, that all per- 
sons are liable to be infected with this disease ; yet 
some are much more so than others. Indeed, this pe- 
culiarity often appears very conspicuous; for while one 
will be, at every period of his life, infected by one 
single -act of indiscretion, others become hoary in 
its repetition, without ever experiencing a single 
symptom of the disease. 

The poison is conveyed into the system by the 
lymphatic vessels, or the absorbents of the skin. It 
is in consequence of their dispersion over the whole 
body, that the virus may be absorbed on any part 
to which it is applied, and by means of their infi- 
nite connections that it may be diffused over the 
system. 

On whatever part, however, this poison is ap- 
plied, it is absorbed more or. less quickly, according 
to the structure of the part, and the peculiarity of 
the constitution, health, &c. of the person exposed 
to its effects. It has, for instance, been observed, that 
if, from the same connection, there should be virus 
lodged upon any of the parts beneath the prepuce, 
and upon the skin of the external parts of the pe- 
nis, and if the the virus act effectually on both these 
parts, there will be a distance of many days be- 
tween their appearance; the virus lodged beneath 
the prepuce acting before that upon the external 
skin. 

The venereal poison, I believe, never acts accord- 
ing to its quantity, but to its specific quality. Like 
every other infectious quality causing disease, it 
undoubtedly possesses greater virulence at one time 






105 

than another, and even in certain intervals may be 
almost quiescent, though not entirely injured, in its 
power of propagating disease. There can be no 
doubt, that the same circumstances attend every 
disease, either of a generally contagious nature, or 
such as the small pox, the venereal disease, &c. 
where the poison is more immediately and directly 
applied. 

Soon after producing chancres, or small ulcers 
on the skin, the infection received in the common 
way, irritating and inflaming the inguinal glands in 
its passage through them to thelsystem, produces a 
bubo in the groin. X 

The immense labour some authors have display- 
ed, in minutely tracing the different periods, from 
the time the infection was caught, to the exact 
moment when the venereal disease made its appear- 
ance, in the many hundred forms which it is said 
sometimes to assume, is more curious than useful. 
Some of the more general remarks may be put to 
some use ; but to attempt to establish a general 
doctrine, upon a multitude of anomalous and uncer- 
tain occurrences, would be at once unprofitable and 
unsatisfactory. 

Although it be from external appearances, such 
as chancre, bubo, or other affections of different 
parts of the body, that we are usually guided in 
our opinions respecting the existence of this dis- 
ease, yet the system is sometimes affected by it, in- 
dependently of either of these symptoms. Jn this 
state we will frequently find, that the glands of the 
groin are more or less enlarged. By this single mark, 
when we have no other leading symptom, we may in 
general ascertain, whether or not the patient be really 
affected with lues venerea ; yet we sometimes find, 
that the venereal virus will pass into the system, 
even without producing either chancres, enlarge- 
ment of these glands, or any other external sign of 
disease. But afterwards, blotches on the skin, ul- 
f 



lo6 

iters on the tonsils, &c. will convince us of its ac- 
tual existence in the system. But I am fully of 
opinion, that from chancre, the disease is more 
likely to be communicated to a sound person, than 
from any other symptom ; still, however, even from 
other symptoms, well authenticated instances of in- 
fection are on record. 

It would, in many cases, be a great difficulty 
strictly to define the venereal disease from appear- 
ances. It assumes so many different symptoms, and 
appears under so many forms, that it seems rather 
every disease, than^udisease. On this account there 
is perhaps no disease incident to the human body 
in which experience and observation are more ne- 
cessary to enable us to form a proper idea of it. In 
this state of difficulty, we must content ourselves 
by enumerating its most general symptoms, and 
from them forming our opinion. It is not the symp- 
toms in one, or even in several individuals, that must 
regulate us in this respect; for in almost every dif- 
ferent individual, and even in the same individual at 
different times, we will find the symptoms vary in a 
considerable degree. On this account, it is neces- 
sary that we should form our opinion upon the 
broad basis of extensive observation, otherwise we 
may be very apt to be led astray. I do not there- 
fore pretend to assert, that I shall relate all the ano- 
malous symptoms which may occasionally occur in 
in this disease, and perhaps scarcely in the order of 
succession in which they may appear in many 
individuals ; but I shall certainly endeavour to take 
notice of the most important of those which most 
commonly occur in practice. 

The recent symptoms, then, of lues venerea, are 
chancre, with or without bubo, and either or both 
of these, with or without phymosis or paraphimosis. 
The disease may, as just mentioned, be, but seldom 
is, introduced into the system without one or other 
of these appearances. When this happens, or 



107 

when the infection, although the above symptoms 
may have existed, and have been hastily healed, 
still remains in the system, it may often continue 
for years without exhibiting one symptom of its 
being present. But if it be thus imperfectly cur- 
ed, we may expect that, at some future period, 
no doubt greatly influenced by various circumstan- 
ces, it will in some form or other make its appear- 
ance. Most commonly, it first affects the fauces 
with inflammation, which speedily proceeds to ul- 
ceration, or appears in the form of eruptions or 
blotches of various kinds on different parts of the 
body On other occasions, though less commonly, 
sensations somewhat similar to rheumatism affect 
different parts of the body, which at length settle 
in one or in a greater number of parts of the bones. 
These are the most common secondary symptoms. 
Still, however, njguy others occur in practice, and 
are to be found described by writers on the ve- 
nereal disease. But these I shall decline enu- 
merating, as I wish principally to confine myself 
to the more common occurrences; and when other 
symptoms appear, which, as I formerly stated, are 
not common, they may, together with their treat- 
ment, be found enumerated in some books, where 
they ate described, and dwelt upon with such in- 
tolerable minuteness, as if they were daily occur- 
rences. 

The order, then, in which the venereal symptoms 
enumerated above, generally appear after the virus 
has been applied to the genitals, and before they 
have been in any way unchecked by mercury, are, /. 
first, in the form of chancre, next bubo, then erup- 
tions or ulcers on the skin, ulcers in the throat, and 
affections of the bones. The first two symptoms 
are not so apt to vary in the order of their appear- 
ance as the tour last mentioned, which, with the af- 
fection of the bones, which are almost always iast, 
or at least in them the pains are last felt, we find 



108 

extremely different in different subjects, both in re- 
gard to time and severity. 

However circumscribed the first appearance of 
lues venerea may be, it will, unless arrested in its 
progress, gradually proceed to affect other parts of 
the body, and at length completely contaminate 
the whole living system, and finally terminate ex- 
istence,, having previously reduced the whole body 
to a complete mass of ulceration, and almost of pu- 
tridity. 

Perhaps there is no form or appearance, which 
human nature is capable of assuming, which ren- 
ders it a more horible spectacle, than the accumu- 
lated evils of a confirmed pox. We sometimes 
have the misfortune to see the most manly and 
elegant form by this means reduced to a complete 
mass of deformity. It is not uncommon to find 
the eyes tender, one or both talk squinting and 
considerably protruded from its socket*; the nose 
flat, and the nostrils discharging stinking matter in 
considerable profusion ; the gums cfnsumed, the 
teeth rotten, the sockets exfoliating, and the breath 
horribly foetid and disgusting ; the neck stiff, the 
joints either large and decrepid, or absolutely rigid, 
and totally unfit for their common offices ; ulcers 
of the very worst kind are on various parts of 
the body ; a ghastly and haggard appearance, and a 
mind, less or more, a complete and irrecoverable 
wreck. 

Of Chancres. 

The first morbid appearance, in general, after 
having had connection with one infected with lues 
venerea, is chancre. The most common situation 
of this affection is under the frenum, the next be- 
hind the glans, the next to that, is the inside of the 



109 

prepuce ; and the rarest situations of it, are on the 
external parts of the penis, and on the parts adjoin- 
ing to it. 

The glans or the prepuce, then, possessing the 
most delicate surface, may be reckoned the usual 
seat of the disease, and in those whose prepuce en- 
tirely covers the glans, it is more apt to appear, 
than when this does not take place ; as in Jews, 
Mahommedans, and others. Bubo, in every respect 
venereal, sometimes precedes chancre, and even 
sometimes exists entirely without it ; but this is by 
no means a common occurrence. Under these 
circumstances, there may exist some difficulty in 
really ascertaining, whether or not the swelled gland 
has been caused by venereal infec tion ; but when 
chancres precede its appearance, there can be little 
or no difficulty in forming a proper opinion respect- 
ing its real nature. 

All the more aggravated symptoms of this disease, 
owe their existence to neglect or mismanagement, 
when it first appeared in a mild form. When 
we consider this important fact, when we reflect 
upon the ease with which all the affections, at least 
ninty nine in the hundred of them, may be com- 
pletely removed by common attention, when they 
appear in the simple form of chancre, we ought 
either to regret, that the patient did not allow him- 
self to be properly advised, at that important period, 
or blush at our own want of knowledge in allowing 
such a disease ever to gain ground upon us. 

A chancre begins in the form of a small, hot, red, 
itching point or pimple. By degrees it increases, 
grows whiter, and, on the head of it being rubbed 
off, there is exhibited a small aperture, discharging 
for the most part a quantity of thin ichor. Some- 
times they are few and distinct ; at other times, 
they are numerous and confluent. Although this 
is the common form and appearance ol chancre, we 
in practice meet with them of a more malignant 



110 

kind, of an irregular figure, having a black, livid col- 
oured cavity, and hard callous edges, and spreading 
deeply and widely. I have, in some, even seen them 
so rapid in their progress, as to destroy a great part 
of the glans penis, before the system could possibly 
be affected by mercury. 

I conceive it to be perhaps one of the very nicest 
points connected with our profession, to ascertain 
the distinction between what is, and what is not, 
a venereal sore. But men, in the habit of seing 
many of these diseases, (unless their time has been 
so much taken up, as not to admit of the possibility 
of thought,) acquire from observation and experi- 
ence a tolerably accurate knowledge of these points, 
but still, even they have been frequently deceived. 

In giving advice, therefore, to the young and in- 
experienced physician, how he may be able, by any 
particular mark, to know chancre, we are much at 
a loss. Owing to this circumstance, I have no 
hesitation in saying, that many belonging to the 
medical profession, who have had but few oppor- 
tunities of examining the real nature of such com- 
plaints, may have given mercury for an excoriation 
and, on other occasions, may have burned a real 
chancre with caustic substances till it actually heal- 
ed, and left the disease in the system. This prac- 
tice has too often been the prelude to those dread- 
ful ravages which we too often observe in those 
who have been affected, and improperly cured. 
I believe, however, in general, that a chancre may 
be known by the round pitted appearance which it 
assumes, as if it had been struck out by some in- 
strument, and that thickening of the parts, which 
is always felt after its first appearance, while al- 
most every excoriation or sore of a similar dis- 
cription, in these parts, has a rugged and uneven 
appearance. 

It certainly is a most important point in practice, 
to ascertain, whether the appearance of chancres is 



Ill 

the first sign of the venereal virus having become 
active, and having just communicated the disease to 
the person in whom it appears ; or if their appear- 
ance is a consequence of their having already taint- 
ed the system, and, as in small pox, only appearing 
externally as a sign of the disease having pervaded 
the general system. I have no hesitation in at once 
giving a preference to the latter opinion, although 
I believe the first to be the most fashionable of the 
present day. 

I have every reason to think, that venereal mat- 
ter, merely applied to any surface, may, immediately 
after its application, be washed off or burned out 
by the adoption of active measures; but when it 
is taken up by vessels, the exact situation of which 
we cannot trace, and when it has laid seemingly in 
an inactive state, almost always several days, often 
for weeks, and then breaks out in the form of chan- 
cre, I think to consider it then as a local disease, is 
downright madness. 

I do not agree with those who think that a malig- 
nant chancre, must have been caused by a similar 
degree of malignity in the chancres of the person 
who infected. The difference is obviously attribute- 
able to the peculiarity of the constitution, to the 
prevailing state of health at the time of infection, 
and to habits of irregularity and intemperance. It is 
thus, that we have the disease milder or malignant. 
Were greater atention paid to these circumstances, 
in these as well as other diseases, our reasonings 
respecting them would be much more accurate than 
they usually are. 

Chancres in women are most frequently to be 
met with on the parts about the external orifice 
of the vagina ; sometimes, however, as in men, 
they appear on the external parts, and then the pe- 
rineum is their usual seat. They also, as in men, are 
larger, and form scabs when they appear externallv, 



112 

but when otherwise situated, they are constantly 
moist, affording a plentiful discharge. 

Chancres in women are much less easily detected 
than in men. Women are liable to frequent ex- 
coriations of these parts, quite independently of ve- 
nereal infection, and unless buboes accompany the 
chancres, they often deceive themselves for weeks 
or even months, and at length, even without tak- 
ing internal remedies for their removal, by washes 
of various kinds entirely remove them, and leave the 
disease in the system. It is particularly owing to 
this, that we often see prostitutes most dreadfully 
affected with secondary symptoms, who even then* 
in numerous instances, cannot be convinced that 
they ever had been affected with the local appear- 
ances of such complaints. 

Of Phymosis and Paraphymosis. 

Phymosis is caused by a soft edematous swelling 
of the duplicature of the prepuce ; or it may arise 
from inflammatory, or from spasmodic action of the 
same part. In consequence of this, the prepuce is 
so thickened, that it cannot be drawn back, but 
projects considerably before the glans, and often 
prevents this part of the penis from ■ even being 
seen. 

Paraphymosis arises from similar causes ; being, 
when the prepuce is short, more apt to recur than 
phymosis. The prepuce thus slips behind the glans, 
and the pressure it makes increases the swelling, 
and consequently increases the disease. Paraphy- 
mosis, however, is almost always caused by a spas- 
modic contraction alone, as we seldom, indeed 
scarcely ever, find the parts preternaturally enlarg- 
ed during the existence of this disease. The glans 
penis is indeed sometimes considerably inflamed 



113 

and enlarged, but this, in the generality of cases, is 
entirely owing to the pressure behind forming para- 
phymosis. A return of the prepuce over the glans 
becomes at length impracticable. Thus a phymosis 
and paraphymosis is the same complaint, in different 
situations. 

In some habits, particularly those of a lax or 
scrofulous nature, when affected with lues venerea, 
sometimes early, at other times latter in the disease, 
I have observed the prepuce become greatly dis- 
tended with a fluid, probably serum, and tnus form 
a sort of anasarcous tumor ; the glans could not be 
uncaped, and a phymosis was thus formed. It is 
remarkable, that this state of the parts, if allowed to 
take its own course, very frequently assumes the 
consistence of cartilage. In this state, I have fre- 
quently removed it, without causing even the slight- 
est pain to the patient. 

Of Bubo. 

Although the first appearance of lues venerea, 
is almost commonly in the form of chancre, yet, 
even without such, I have frequently observed the 
first symptom that gave alarm, to be buboes in the 
groin ; and although not so frequent, inflammation 
and ulceration of the tonsils, or eruptions of the 
skin, or pain and swelling of the bones, in various 
parts of the body, have appeared before any other 
symptom. 

That which constitutes bubo, is an inflammation 
of one or more of those glans, situated nearest the 
part to which the venereal virus was applied. They 
appear in the axilla, when the virus is applied to an 
abraded surface on the hand ; in the neck, when it 
is applied about the mouth in the act of kissing ; 
but they are most commonly found in the~groins, 
because the virus is most commonly applied to the 
genitals. 



114 

They have always been supposed to owe their 
origin, to the absorption of matter from chancre, or 
even from a formerly ulcerated bubo; and that they 
sometimes arise from this cause, is very possible ; 
but it is evident, I should imagine, that, from the fre- 
quency of their occurrence after the application of 
caustic, or irritating substances of any kind, they of- 
ten also alone exist in consequence of irritation being 
produced from the use of these substances. They 
also appear when, even from the minutest examina- 
tion, no first infection can be found in any part of 
the penis. In this st^te, bubo constitutes the first 
symptom, but, as arising from chancre, it can only 
be considered as a secondary symptom. A. bubo, 
therefore, shows us, that the virus has proceeded 
so far from the point where it originally entered 
the system. 

In bubo, from the absence of every other symp- 
tom, we are sometimes obliged to judge of it being 
of a venereal nature, from the patient having recent- 
ly had connection of a suspicious nature ; and from 
the bubo proceeding to suppuration. It is, at all 
events, (he safest conclusion we can draw. 

That such things as sympathetic buboes exist, 
quite independently of any venereal cause, is cer- 
tain ; when suppuration occurs in the inguinal 
glands, while the venereal virus is actually in the 
system, we, I think, act properly in considering 
them as strictly connected with, and in almost every 
case similar to, the disease itself. A belief of every 
inguinal suppuration, (which is by no means an 
uncommon mode of arguing,) being strictly of a 
sympathetic kind, when its origin cannot be traced 
precisely to the effect of the venereal virus, quite 
independently of all other external or interal cir- 
cuu trances, has, I am sure, been productive of much 
mischief; certainly of at least as much as the too 
common custom of the day, of considering venereal 



115 

eruption as not at all, or at most but slightly, con- 
nected with that disease. 

Young people are more apt to be affected with 
buboes, than old, in consequence of the activity of 
the lymphatic system. When, in old age, the skin 
shrinks, and becomes loose, these glands seem to 
have done their office, and become inert. 

In the commencement of bubo, the groin feels 
at first stiff, and this state is soon succeeded by 
pain ; swelling in general of only one gland, takes 
place, and for several days is apparently confined 
to that gland alone. It, however, soon diffuses it- 
self, and often occupies considerable extent. The 
pain then is greatly aggravated, and, in some instan- 
ces, there is added to the pain a sort of burning, 
and very disagreeable sensation ; the parts assume 
a dark red, or rather purple appearance, and, in a 
greater or shorter time, matter is formed in it, and 
it bursts externally. So far as my experience en- 
titles me to judge, buboes in scrofulous habits* 
suppurate more slowly, than when no such affection 
can be traced in the patient. 

Were the venereal virus weakened by being thus 
diffused, the greater extent of surface that it occu- 
pied, and the longer it remained in the system, 
the easier would its removal be. But this we 
know is not the case, so that the virus evidently 
possesses the power of self-propagation, and in this 
State of progress has enlarged its sphere of action. 

A gland once enlarged does not, often for life, 
return to its formdr healthy size ; and, therefore, 
although the state of the inguinal glands often point 
out constitutional affections, yet our prognosis 
must not wholly rest on them ; we must have other, 
causes to assist out suspicions. 

Although a swelled testicle is most commonly an 
affection attending on gonorrhoe i, yet, in some in- 
stances, it is to be met with during the existence 
of lues venerea. In the latter, it is never so acute, 
I 3 



'Krj{ j\,i^f<U^ oL* <to*+f- 



%&£».* 



116 

as in the former ; as the surrounding parts seldom^ 
if ever, inflame, and the affected testicle can he 
handled, without occasioning any considerable pain. 
Besides, it possesses a smooth surface, nor is it at- 
tended with stinging pains, which distinguish it from 
scirrhus of these glands. 

Of Eruptions and Ulcers. 

The venereal eruption is seldom elevated above 
the skin. In some instances, it is much diffused, 
in irregular masses, and changes a great part of the 
skin to a tawny hue ; but its most common seat 
will be found to be about the breast and shoulders. 
It often appears and disappears spontaneously, leaving 
marks behind it. This erruption, too, will some- 
times assume a yellowish, or red appearance, of small 
distinct spots ; at other times they will be very 
broad, and much inclined to spread. Ulcerations 
sometimes appear on the head among the hair, and 
prove very troublesome ; these are most commonly 
found on the forehead, and are known by the name 
of corona veneris. The palms of the hands, and 
soles of the feet, break out in clefts, which, yielding 
a disagreeable discharge, prove extremely trouble- 
some. The corners of the mouth, and alae of the 
nose, too, are by no means an uncommon seat of 
this affection. 

These venereal sores, then, may arise either from 
venereal virus being recently applied to the body, 
or they may appear at a future period ; the venereal 
infection, in the interim, not producing symptoms 
marked conspicuously enough to excite any degree 
of alarm. In the former, they most commonly ap- 
pear on or about the external parts of the genera- 
tive organs ; in the other, they more commonly 
appear on other parts of the body. 



117 

In the natural attempts then of the system to ex- 
pel all noxious and hurtful diseases, the venereal 
vinos, after remaining various lengths of time in the 
habit, is thrown out upon the external parts. In 
this state, if not entirely removed, it often remains 
for months, or even years, without doing much 
farther mischief. If, however, it be not at all check- 
ed, it again proceeds to commit fresh ravages on 
the system, and that in a more extensive way than 
formerly. The internal parts and organs nearly 
connected with existence, are now apt to be affect- 
ed, and many instances of death might be ad- 
duced, which had solely been caused, either by ne- 
glect or bad treatment in the earlier stages of the 
complaint. 

After the virus has been absorbed into the habit, 
and all the sores, as first signs of the disease, have 
healed, the time of the appearance of constitutional 
symptoms is extremely indefinite. In short, we 
must judge, not so much by the time the disease 
has existed in the system, as by the appearances that 
present themselves. 

When this disease, then, in its usual early forms, 
has not been properly cured, we find, that at vari- 
ous periods of time, from a few weeks to the lapse 
of many years, secondary symptoms are the usual 
consequences. In some instances, the eruptions 
are purely cuticular, at other times, they appear in 
large blotches, seemingly deeper seated, and in 
others in the form of deep ill-conditioned ulcers. 

We find, too, that while the venereal disease re- 
mains lodged in the system, even although it pro- 
duce no local symptom, the general health, especially 
previous to its appearance in the form of eruptions, 
ulcers, &c, is almost always impaired. There is an 
unaccountable langour and depression of spirits, 
prostration of strength, restless nights, a degree of 
pain in the various bones, or rather a sort of tight- 
ness, as if they were bound with a cord. But at 
I 3 



118 

this period, the pain of the hones is never so acute 
as in confirmed venereal affections principally af- 
fecting these parts. From the feeling of the pa- 
tient, they seem rather to be lodged about their ex- 
ternal surface than in the body of the bone. The 
sleep yields neither comfort nor refreshment, there 
is a disagreeable sensation felt all over the body, 
which is almost always accompanied by emaciation ; 
and not uncommonly there is an indescribable al- 
teration, of a very unpleasant nature, in the fea- 
tures of the face. 

Venereal blotches, if not properly attended to, 
terminate in venereal ulcers, often of considerable 
depth, discharging ill-conditioned matter. These 
ulcers, however, often occur, although no blotch or 
erruption has preceded them, but merely by the 
parts becoming inflamed, bursting, and forming 
such sores, which are in most instances hollowed, 
and less or more filled with a spongy substance. 
Their discharge is thin and brown, and when they 
appear over any bone, which they usually affect at 
the same time, the discharge is very foetid. 

/ & 
Of Sore Throat. 

There is often considerable difficulty in drawing, 
from the appearance of the sores, an exact line of 
distinction, between ulceration of the tonsils and 
fauces, from venereal and common inflammation. 
Venereal ulceration in the throat, has a white ap- ' 
pearance, as if a piece of hog's lard had been placed 
on the surface, and is almost always much less in- 
flamed than the other. Indeed, bloatches or ulcera- 
tion from this cause, on any other part of the body, 
are less so than inflammation from common causes ; 
they are less painful, are more foul, and not easily 
cleaned by any kind of gargle we can use, and the 
voice of the patient is likewise greatly altered ; all 
which symptoms are not so common in the usual 



U /-€? 



H9 

cases of inflammation of these parts. Much, how- 
ever, must be known by the history of the com- 
plaint, previous to our administering mercury. 

This form of the disease, when it has continued 
for some time, acquires a burning disagreeable sen- 
sation, which is even more unpleasant than pain it- 
self. It not unfrequently affects different parts of 
the mouth ; proceeds to the fauces, and then to the 
nose, and whatever part of this organ may be af- 
fected, there generally appears upon it a brown 
scab or crust, or the sores are very foul, and have 
thick, edges'. When the discharge becomes thin, 
brown, and foetid, then we have reason to suspect 
that the contiguous bones are affected. Parts of 
these, such as the bones of the palate, are sometimes 
wholly affected. The disease then proceeds to af- 
fect the triangular bones of the nose, and the spon- 
gy bones are often separated, and the power 
of breathing through the nose becomes imper- 
fect. The nose swells, is inflamed internally, 
and the eyes in general constantly pour out a pro- 
fusion of tears. A general wreck of the organ at 
length takes place; the spongy bones come entirely 
away ; the septum also falls off, and the cartilaginous 
parts becoming almost flat with the face, the voice 
is, in many instances, completely changed, if 
not almost entirely destroyed. Foul, ragged, 
and ugly ulcers appear on various parts of the 
cheeks, 8cc. the teeth drop out, and the breath is 
horribly foetid, and the aspect altogether assumes a 
most horrible appearance. 

As intimately connected with this subject, and 
the article immediately preceding, I may notice 
here the subject of diseases resembling venereal. 

There is a doctrine now very prevalent, which I 
beg leave to deprecate here, as it leads to very oad 
consequences in practice. 

It is founded on the fact, that all sores which re- 
semble syphilis, are not syphilitic. 



120 

This fact was well known to Wiseman, who says, 
« #1 would not have any man rash in judging all 
ulcers to be venereal, that do resemble them ; for I 
have seen nurses with chapped nipples, and serpi- 
ginous ulcers on the breast, and maids likewise in 
the same condition, who have been cured without 
any respect to the lues. I have seen also many in- 
fants broken out about the lips, face, head, andbody ; 
with many suspicious pustulae and ulcers, that were 
born of chaste parents. 

Mr J. Hunter is of opinion, " that there arise 
every day new diseases resembling syphilis." 

That syphilis, then, is exactly resembled by other 
diseases, is certain. On this subject, I am inclined 
to agree with Pearson, -f- who says, " there is 
scarcely an appearance produced by lues venerea, 
which is peculiar and appropriate to. that malady, 
and which has not occurred as a character of some 
other disease. 

It is of great importance to know this, as a pa- 
ralogical truth, particularly where our opinion may 
interest the welfare of families ; but of late it has 
been urged to a very dangerous length, by Aberne- 
thy and others, who, I doubt not, allow people, at 
the risk of their lives, to labour under complaints 
that might be cured by mercury, from the idea 
that they are not venereal. 

The mode of reasoning, (if reasoning it can be 
called.) employed by Abernethy, is conspicuously 
absurd. Although this gentleman allows, " that in 
some constitutions, thevenereal disease may assume 
unusual characters, and be very difficult of cure ;"— r 
yet he says, if mercury remove the disease too 
speedily ! then the disease is not venereal ! ! ! page 
141 |, U mercury cure it slowly and permanently, 
then it is not venereaj ! ! ! p. 1^1. 

* Lib. VIII. Chap. I. Of Lues Venerea, p. 4. 

■f Pearson, on Lues Venerea. Introduction, p. 3, 

j Essays, &c. See the Book. 



121 

If the disease recurs after the use of mercury, 
and has only been checked by it ; then it is not 
venereal ! ! ! 

If mercury aggravate the disease, then it is not 
venereal. 

If the disease continues for months uncured 
without mercury, and be cured at last when mercu- 
ry is exhibited; then it is not venereal. 

In page 143, he says, " in some later cases, when 
the disease has been long protracted, and the pa- 
tient very anxious to get rid of it, I have given a lit- 
tle calomel for that purpose ; but not so as to inva- 
lidate the opinion, that the disease was not syphili- 
tic. Having waited, for instance, four months 
from the occurrence of the sore throat, with erup- 
tions ; and being certified, by the progress of the 
disorders, that they were not syphilitic, I have di- 
rected, that one of the compound calomel pills, 
should be taken every second or third night, which 
generally disposes the sores in the throat to heal ; 
but I have taken care to remit the use of this small 
quantity of mercury, if it seemed to heal the sores 
too speedily ! ! I * for it seems to me better to let the 
disease exhaust itself ! ! / (and the patient too !) 
than suddenly to cure it ; as, in the latter case, it 
is very likely to return," &c. This appears to me 
most extraordinary practice, and equally extraor- 
dinary reasoning. Is it allowable for a medical man 
to know what will cure his patient in a short time, 
and yet permit the disease to remain, that it may 
be ascertained whether it will disappear spontane- 
ously ? 

Have we a right to conclude, because a small 
quantity of mercury, in the form of calomel, spee- 
dily and unexpectedly removes the affection, that 
the affectipp, therefore, is not venereal ? 

* Let this be compared with the next extract, and it will be 
seen that the gentleman is only talking at random. We roust 
Conclude, that he practises similarly. 



122 

Are we again to revive the barbarous doctrine, of 
allowing diseases to exhaust themselves I ! ! ; or to in- 
termit the proper remedies, least the return of health 
should injure the patient ! ! ! ? I think the author, 
in the next edition of his pamphlet, should advise a 
fresh infection, that the disease may riot in the sys- 
tem with renovated violence, and have a fairer op- 
portunity of exhausting itself ! I ! This, according 
to Mr Abernethy' s principle, would be leaving no- 
thing undone, but would completely finish the bu- 
siness, and I am convinced would place the patient 
beyond the reach of further infection. 

Let us compare Mr Abernethy with himself, in 
page 157- — " It follows, as a general rule of con- 
duct, in practice, that surgeons are not to confide 
in their powers of discrimination ; but, in all cases 
of ulcers arising from impure intercourse, to act as 
if the sore was venereal ; to give sufficient mercury, 
slightly to affect the constitution ; to guard against 
the consequences of absorption ; and, by local and 
general means, to cure, as quickly as possible * , the 
local disease, and thus remove the source of conta- 
mination, and the necessity of the continuance of 
medicine ; this is, I believe, the general rule of 
practice, adopted by the best surgeons ; and it ap- 
pears to me, in the present state of our knowledge 
of these diseases, to be judicious." Yet just before, 

* Let this be compared with the preceding quotation. The 
public have rarely been troubled with such instances of glaring in- 
consistency, actual contradiction, and defective reasoning, I de- 
clare, that, understanding Mr Abernethy to have acquired some 
reputation in London, I, on reading this paper, exhibiting his rea- 
soning and practice in venereal affections, first imagined, that 
some other person, with the intention of ruining him, had borrow- 
ed. his name j afterwards I conjectured, that he himself meant to 
satvrize this prrticular branch of the profession j and my astonish- 
ment was indescribable when 1 found, not only that he was serious, 
but that J was blamed for pointing out his errors, by reviews, &c. 
on the 6ole ground, that Mr Abernethy was a very modest goad 
sort of a man, and withal, high in the profession in London. 



123 

Mr Abernethy declares it is not adopted bv him. 

The second second section of Mr Abernethy's 
paper appears to me, with few exceptions, either 
unintelligible, or quite absurd. 

Mr Blair, too, has a singular mode of reasoning. 
Those cases that resisted mercury, and were after- 
wards cured by acids, &c. were not venereal : 
Why ? because the mercury did not cure them ; 
and those cases that were cured by the acids alone, 
were not venereal : Why ? because they were cured 
without the aid of mercury ! ! ! On these princi- 
ples, it is impossible for us ever to discover that any 
other substance than mercury can remove syphilis. 
An odd arrangement of nature ! ! !* 

Gentlemen might indulge in their reveries un- 
noticed, if their influence were not detrimental ; 
but when these reveries are erected into practical 
maxims, destructive in their tendency, they cannot 
be too speedily nor too pointedly exposed. 

I have known many bad effects of the influence 
of these premature maxims. 

A gentleman (who had doubtless been under 
such treatment as the above), applied to me on ac- 
count of a very slight excoriation on the inside of 
the prepuce, which he would not admit of being ve- 
nereal, and he removed it, by external mild appli- 
cations, in a few days. About a fortnight after, he 
consulted me again on account of his wife, who 
was now affected with many chancres and large bu- 
boes in each groin. She was cured by mercury, 
and he also was at length convinced of the proprie- 
ty of submitting to the same treatment. 

A friend of mine-related to me another interest- 
ing instance of the same kind. 

A young gentleman had an excoriation, about 

* I most sincerely hope, that, for the sake of humanity, and the 
honour of the profession, this is not the general mode of reasoning 
and practising in London. 



124 

the size of a sixpence, on the dorsum penis. As 
the gentleman confessed his having exposed him- 
self to infection, my friend advised him to use mer- 
cury internally ; but an eminent practitioner pro- 
nounced it not to be dependent on pox; conse- 
quently it was healed as a common excoriation. 
The gentleman was now under the necessity of go- 
ing to the West Indies ; and in six months after he 
had left Scotland, without any new infection, he 
was severely attacked by secondary symptoms, pain 
in the bones, ulcers in the throat, &c. and was at 
last cured by a very tedious and distressing course 
of mercury, which, with the disease, nearly destroy- 
ed him. Yet even here, the gentleman had not 
reached the felicity of allowing the disease to ex- 
haust itself ! 

Of Nodes. 

Pains in different parts of the body, from a ve- 
nereal cause, are, unless we are very attentive, ex- 
tremely apt to be mistaken for those of another 
kind. In some, there is a degree of stiffness or 
tension of the parts ; and, when they affect the 
great joints, such as the knees, there is, on moving 
them, a sort of crackling sensation distinctly felt, 
but this is unattended by pain. In others, the 
pains are darting, and in others, still a throbbing 
sensation is felt. Thus, in affecting spme parts, 
they are thought to be rheumatic, if about the joints, 
they are thought to be gouty, and in the loins, lum- 
bago, &c. 

These pains first occur in the periosteum and ten- 
dons, and arise from their diseased action. The 
disease, still continuing to make progress, arrives at 
a state of the greatest acuteness. Thus, the liga- 
ments and tendons often suffer from venereal 
causes, as if the parts were proceeding to suppuration ; 
and there is at the same time produced on them a 



125 

a tumour hard at first, but afterwards becoming soft 
and containing a sort of glairy mucus. The parts 
are exquisitely tender, particularly to the touch, and 
in time, the tumor breaks, and spreads into a foul 
and spreading ulcer. This affection, from its situ- 
ation, is often mistaken for gout, and obstinately 
treated as such. 

It appears, that nodes and caries of the bones, 
are the latest symptoms of the disease. Yet it is 
extremely probable, that, from the beginning of 
the primary constitutional symptoms, it continues, 
though perhaps not visibly, to act on every part 
alike. 

Ultimately in the bones, the pains become more 
fixed, increased in severity, and more constant, espe- 
cially while the patient is in bed. 

When a cylindrical bone is affected in this way, that 
disease often occupies its whole extent, terminating 
only at each epiphysis of the bone. The diseased 
part, is exquisitely tender to the touch, the perios- 
teum is thickened, and the part most violently af- 
fected becomes slightly edematous. It at length 
inflames and ulcerates, and the bone is not uncom- 
monly found in a diseased state. If it be not actu- 
ally carious, one or more distinct nodes may be 
found on it. 

Although nodes on the bones, then, sometimes 
Cause ulceration of the affected parts> and in such 
instances, the bone is found to be in a greater or 
less degree carious ; yet this is not a common ter- 
mination of nodes, for, in general, with ordinary at- 
tention, they are entirely discussed. I have met 
with them most frequently among the young and 
the thoughtless, who too often, till their constitu- 
tion be completely destroyed, act in every respect as 
if they were not composed of those frail materials, 
which^ even under the Most careful management, 
are soon reduced to a wreck. 



126 

The bones at the extremities also, where they are 
less compact, become enlarged by degrees.' Yet 
the pain there is not so intense as in the harder 
bodies, but it is not uncommon for an anchylosis 
to be the consequence of such enlargement. 

The symptoms and appearances, which I have 
mentioned, as arising from lues venerea, are scarce- 
ly ever to be met with in the same patient at once ; 
yet, from peculiarity of constitution, treatment, 
&c. he is subject less or more to them, even from 
the very slightest to the most horrid mass of putre- 
faction and deformity which this disease is capable 
of assuming. 

It may be mentioned here, that we have some- 
times opportunities, in practice, ot meeting with pa- 
tients, who, without a single external appearance, of 
other symptom, are decidedly certain that they are 
affected with lues venerea. I have known this de- 
lusion withstand even four courses of mercury, and 
the patient continue in perpetual misery, in the 
dread of losing his nose, or becoming otherwise 
maimed or disfigured, in consequence of this sup- 
posed state of his body. No reasoning has any effect 
with such persons, and their physician is deemed 
skilful or otherwise, just in proportion to the be- 
lief he expresses in their assertions* 

Of late Symptoms. 

Various symptoms of lues venerea occur for the 
most part late in the disease, such as blindness, when 
one or more of the humours of the eye become 
diseased ; and deafness, when the eustachian tube 
is partly obliterated, and sometimes when the bones 
of the internal ear become diseased and separate ; 
the skin, too, of the palms of the hands and soles 
of the feet often break, producing painful and very 
troublesome sores ; but the most distressing of all, 



127 

is a sort of hectic fever, which wastes the body of 
patient, and from which many have died. 

The eyes, in advanced venereal affections, are of- 
ten ravaged by the disease: The eye- lids become 
thickened, itching, and even ulcerous; the eye dis- 
charges a thin acrid fluid ; the cornea becomes 
opaque ; even the humors are vitiated, and vision 
is consequently destroyed. 

The ears too become affected with a hissing noise. 
All the internal parts suffer violent pain, the small 
bones become carious, a foetid discharge proceeds 
from them, and an aching pain and a dullness of 
hearing precedes a total deafness. 

Falling off of the hair does not seem a symptom 
peculiar to lues venerea, although it is sometimes 
an attendant on that disease. From various cir- 
cumstances, however, we may be enabled to judge 
of the connection of this symptom with lues ; but 
we must be careful, if the patient has been under 
a long course of mercury, as from that alone, this 
symptom may be adduced. 



128 

PART IV. 
TREATMENT. 



Introductory Remarks. 

While there are no diseases of such frequent 
occurrence, or such high importance, as those 
either actually existing in the generative organs, or 
affecting the general system in consequence of their 
long continued derangement, there are certainly 
none, in which our plans of treatment ought to be 
regulated with greater judgment, to suit the various 
changes which occasionally occur in our progress 
toward a cure. 

In some of these diseases, and especially in those 
which are primary, for instance, such as gonorrhoea, 
lues venerea, &c, there has too long existed a ne- 
glect of scientific discrimination, and an undistin- 
guishing routine of practice. This- practice has its 
antiquity alone to recommend it; but, in conse- 
quence of this recommendation, weak as it certainly 
is, innovations, however scientific and beneficial, 
are ever timidly and slowly received. 

With respect to the treatment of chronic affec- 
tions of the generative system, they have, for the 
most part, been openly acknowledged to be difficult 
of removal, and the majority of the most respect- 
able writers on the subject, have even asserted the 
utter impossibility of removing some of them. In- 
deed, the avowed want of all success, except per- 
haps of the most temporary kind, which has uni- 
formly attended the treatment of these chronic dis- 
eases, is a proof, which no unsupported assertion 



ng 

can overturn, that neither their nature nor treat- 
ment have been at all understood. 

These affections, when nearly connected with 
the immediate parts, are those beyond which medi- 
cal men have neither extended their investigations, 
nor advanced any useful practical doctrines. But 
these, however important, (for important they are 
in their nature, limited even in this degree,) can 
never be compared to the dreadful ravages which, 
unless prevented in both sexes, are at length inva- 
riably produced on the general system. In short, 
if any thing can stimulate us to vigorous exer- 
tion, it is the recollection, of the effect of our 
failure in the removal of these diseases. In them 
the whole catalogue of human miseries often seem 
concentrated in the haggard and emaciated fabric 
of one miserable individual; and that which renders 
his situation lamentable beyond description, is the 
reiterated failure of those assurances of amelioration, 
which, at every change of prescription, he was con- 
fidently assured would yield him relief. 

But when we consider the reasoning, (if reasoning 
it may be called,) which seemed to indicate the 
propriety of the practice employed, we shall not be 
astonished at these failures being even more fre- 
quent than we are made acquainted with, or than 
at first sight they appear to be. The mistake prin- 
cipally takes place in the following way : When 
the body, from the continuance of such diseases, 
becomes affected with extreme debility, and when 
the mind also partakes of the general decay, the 
disease is falsely denominated hypochondriasis, or 
a violent nervous affection, or something else, which 
may permit some extremely difficult or utterly un- 
intelligible definition, and the escape of the practi- 
tioner from farther enquiry. For these, consequent- 
ly, alleviation may be procured, but scarcely any 
mode of permanent relief. v 

Thus a long list of pretendedly incurable diseases 
has been invented j words have deen substituted 



130 

instead of facts ; and the world is daily deceived by 
a repetition of similar mistakes. 

During this absence of discrimination and of ra- 
tional treatment, the worst consequences arise from 
the insidious nature of these diseases. Although, 
perhaps, for many years, the general health of such 
patients is but now and then violently affected, 
and although such a state does not for some time 
threaten immediate dissolutions yet such affections 
are sure to increase in violence, and entail more 
and more irremediable mischief upon the system. 
Under these circumstances, when the most uni- 
formly and speedily successful treatment ought to 
be employed, and either firmly persevered in, or al- 
tered according to its evident effects in the res- 
toration of the patient's health, packet after packet 
of various medicines are alternately poured into 
the stomach, and accident, not scientific reasoning, 
is alone entitled to our acknowledgments, when 
such proceedings do fortunately no very material 
harm. 

Very early in practice, I acquired a dislike to 
those immense multitudes of different drugs, of- 
ten possessing different, or even opposite qualities, 
which, at one time, were generally crowded into all 
prescriptions, and which are even in the present 
day too often recurred to. To remedy this, I have * 
sacrificed much, and am still willing, if necessary* to 
sacrifice more. 

With regard then to the cure of gleet, &c. in the 
male, and that of leucorrhcea, and a numerous list 
of the most important and distressing complaints 
of the female, (which have usually been deemed ir- 
remedible,) when my friends first persuaded me to 
make public the result of my experience in the 
treatment of them, I thought that little more would 
be necessary, than a relation of the cases that had 
fallen under my observation ; but, on considering 
the subject more fully, I was convinced that this 



131 

plan would be by far too limited. The complaints 
themselves not being previously sufficiently under- 
stood, nor distinguished from others somewhat of a 
similar nature, with any degree of precision and ac- 
curacy, the indiscriminate use of the cantharides, 
for instance, might and certainly had been fraught 
with mischief; and, on many occasions, even in 
complaints of the same nature with those in which 
its use was indicated, other remedies might have 
been used with more propriety. Neither the prin- 
ciple of the operation of that medicine, nor the cir- 
cumstances of constitution in which they should be 
had recourse to, or prohibited ; nor the combina- 
tions of disease, which would frustrate our design 
in the administration of them, or which might en- 
tirely contra-indicate their use, and in which con- 
sequently their operation might be hurtful, — seemed 
to be understood. Besides, there prevailed preju- 
dices and fears against them, which it was necessary 
to confute, overcome, and remove. 

I found, also, that my own views with regard to 
this medicine became daily more extensive ; that 
its powers, in exciting the action of the living body, 
in extent, efficacy, and utility, far exceeded any thing 
that either I or any other human being could have 
expected, since by it we can maintain and regulate 
that action which is indispensibly necessary for the 
accomplishment of the salutary purpose of their ad- 
ministration. Besides, the range of bodily infirmi- 
ties and affections, in which they evinced those 
generally stimulating properties, were not only very- 
numerous, but such as other means were generally 
employed to cure without success. The previous 
paleness and debility, with want of ability for ex- 
ertion, and the soft flabbiness of the muscular parts, 
which previously existed, gradually disappear after 
they have been used for sometime, and the patient 
becomes stout, and, in general, of a healthy ap- 
pearance* 

1 2 



132 

With regard to all the diseases, then, which I have 
detailed, and which I shall point out as remediable 
by that medicine, innumerable circumstances show 
them to be purely those of debility. In a majority 
of cases, we can trace their existence to a previous 
overaction of the whole sanguiferous system, which 
is acknowledged by every one to be productive of 
debilitating effects. But more commonly they are 
such as depend on a similar overaction of this 
function in some particular series of organs ; most 
commonly of those of the generative system. In 
the latter case, it is, after the continuance of the 
disease, arid during a considerable length of time, 
by no means an uncommon occurrence, for the ge- 
neral system to become remarkably affected with 
various forms of disease, all of which, varied as 
they may appear, can only be permanently removed 
by restoring the tone of the parts, the loss of which 
first occasioned them. The powers of digestion 
fail, and occasional vomiting is by no means un- 
common, and the bowels are in general constipated. 
The sight, too, and hearing, and memory, are, espe- 
cially in severe cases, very considerably impaired ; 
so much so, indeed, that I have known some pa- 
tients totally unable to follow any occupation^ or in- 
dulge in any amusement, where the exercise of ei- 
ther of these faculties was absolutely requisite. 

Some, I may remark, think, that it is a great ar- 
gument against any substance employed as a medi- 
cine, when it is affirmed to be useful in very many 
complaints ; and for the most part indeed it is so, 
because empirics openly declare their particular 
nostrums to be good for all complaints, however 
opposite their nature. But it is a very different 
case, when the same substance is found useful in 
complaints which, though differing in name, from 
certain local circumstances, or in the parts princi- 
pally affected, are really of the same nature. This 
becomes a strong argument in its favour. 



133 

It is., I may mention, a melancholy, but well es- 
tablished fact in our profession, that the violence 
of opposition, which any improvement, either in 
surgery or medicine, meets with, is too often, at 
least for a considerable length of time, exactly in 
proportion to its importance in the removal of dis- 
ease. While, with the greatest facility, any mys- 
terious agent which can be proposed for the re- 
covery of health, is, without the least scruple or 
even attention to their too often fatal consequen- 
ces, admitted into universal use ; that which, to a 
demonstration, can be proved of the greatest bene- 
fit to the human race, is, when used, employed 
with fear and trembling, and seldom before at least 
a century or two elapse, so universally, or to such 
extent, as alone can insure all the utility of which it 
is capable. 

In that part of my practice, in particular where 
the cantharides requires to be employed, it were un- 
reasonable in me, therefore, not to expect the most 
determined opposition. I am well aware that party 
spirit is exerted exactly in proportion to the effect 
of any newly proposed remedy in cure of disease ; 
and the proposer, together with the remedy, without 
giving either the opinions of the one, or the powers 
of the other, a fair trial, are often nearly overpower- 
ed by that concentrated mass of stupidity and in- 
fluence, through which the light of science can 
never penetrate. Their contracted views are cal- 
culated solely for the comfort and happiness of 
themselves, not, except in mere form, for the allevia- 
tion of that mass of human misery which, while it 
perpetually surrounds us, calls aloud for our inter- 
ference and relief. • 

Since my publication on the internal use of can- 
tharides appeared, I have, independently of these cir- 
cumstances, had numerous opportunities, not only of 
confirming the doctrines there advanced, but of ex- 
tending my views on that subject to a much great- 
er extent than I at that time ever expected. My 
i3 



134 

experience, on that subject, is now not only general, 
but, on the principles I then hastily delivered, uni- 
formly successful ; and the numerous favourable 
communications, which I am daily in the habit of 
receiving, from every part of the country, convince 
me, that in a much shorter time than important im- 
provements in the practical part of our art, com- 
monly meet with public sanction, this, practice will, 
when under proper regulations, at once become 
still more general, and more extensively successful. 

I know that objections, from want of success, 
have been started to the treatment of several dis- 
eases by the cantharides. Such objections I was 
prepared to hear, whenever I should make known 
the success of my practice with that substance. 

To those, however, who without prejudice, or a 
wish to condemn, give the cantharides a fair trial, 
in such complaints as, from what I shall state, may 
indicate its use ; and who really have been unsuc- 
cessful, I have only to observe, that I can easily ac- 
count for the failure of many medical practitioners 
in the treatment of diseases by this substance It 
was not, till after many years experience, and the 
closest attention I could bestow to its operation, 
that I became decidedly successful in the removal 
of complaints with that medicine, and even then 
failed in the removal of some cases, which, with 
still greater experience in the use of it, I have since 
completely effected. It will undoubtedly be with those 
practitioners, as it was with myself; but, by cautiously 
persevering in its use, and carefully watching its o- 
peration, they will be sensible of its importance. 

With regard tothe cure of venereal, as well, indeed, 
^s other complaints of the generative system of both 
sexes, no extent of reading, even the best books on 
these subjects, can, unless by accident, or in the very 
mildest form of them, enable us to do justice to our 
patient. Thus taught, the greatest success we can 
expect, is by some lucky accidental application ; 



135 

while the chances of error are innumerable. It is 
alone to experience, and scientific discrimination, 
that we are to trust for either safety or success in 
their entire removal. These diseases, in their va- 
rious stages, assume different forms, each of which 
requires a plan of treatment peculiar to itself. Al- 
though many of these changes may be described 
in books with tolerable accuracy, others can be best 
understood by the actual observation of one who is 
in the daily habit of suiting his practice to these 
changes, as they occur, and not regulating his pro- 
ceedings entirely by stubborn rules, or by the book 
he has been last reading. 

Yet no other diseases, to which the human frame 
is liable, are treated more by stubborn, general, and 
hackneyed rules, than those of the generative sys- 
tem ; and, excepting in their very mildest form, 
none seem to require nicer discrimination, attention, 
and alterations, in the plans of treatment, suited to 
the difference of constitution, and of the numerous 
appearances these diseases frequently assume. This 
generalizing plan, or total neglect, sometimes on 
the part of the patient, sometimes on the part of 
the physician, and not unfrequently on the part of 
both, or even injudicious treatment, which must 
solely be owing to the medical attendant, has often 
reduced a once healthy and robust consitution to 
the greatest possible degree of lingering misery. 

I have always been of opinion, that much, even 
of reasoning and philosophizing, has been ingeni- 
ously employed by authors, respecting many points 
relating to these diseases, from which it is impossi- 
ble, for either themselves or others, to draw one 
doctrine usefully practical. These reveries, T 
would call many of them, consequently become ex- 
tremely embarrassing and perplexing to the student 
or the young practitioner, and can be of no service 
to him of greater experience, It would render the 
subject at once more simple and more extensively 
14 



136 

beneficial, were such authors to recollect, that specu- 
lations are only useful in proportion as they can be 
more or less advantageously applied in unravelling 
mystery, or in curing disease ; and that, in propor- 
tion as they deviate from this, they become either 
useless or hurtful in their application. - 

Authors, too, in these speculations, often begin 
their researches, and make experiments rather for the 
purpose of forcing these researches and experiments 
to yield to some preconceived notion, than tobe guided 
and instructed by their result. Thus, determined to 
prove a point, they at length work themselves into 
an actual belief of its correctness, and no future re- 
monstrance, reason or experience, will ever con- 
vince them of the reverse ; not that they conceive 
themselves entertaining a wrong opinion, and pro- 
pagating perhaps hurtful doctrines, but that they 
have, by habit, brought themselves into a most re- 
ligious belief of its correctness, and even of the ex- 
tensive utility that must result from its application. 

In the works of many authors on this subject, 
I am sorry to find these observations too appli- 
cable, and that vague and illusory theory, rather 
than observation, has too often been the sole source 
from which they have derived their practical know- 
ledge. Those who have attended to the various 
changes and appearances which take place, in per- 
haps every case of these complaints, being aware of 
the impossibility of laying down general rules appli- 
cable to all cases, must often have been astonished, 
as well as mortified, to find descriptions of their va- 
rious stages, method of cure, &c. worked up with 
all the precision of a rule in arithmetic, or a mathe- 
matical problem. That there are a few general 
rules in their treatment, I admit ; but, from them, 
without attentive observation, particular rules can 
never be deduced ; and the authors, as well as practi- 
tioners, who are in the habit of writing about, or at- 
temptingtocure such complaints on other principles, 



137 

may assure themselves, that their success will bear 
no proportion to their disappointments. 

It would be well that such speculative practi- 
tioners would, in preference to their present plans, 
adopt the sound and solid practical reasoning of 
some of their ancestors. Although they had many 
faults, yet these in general consisted rather in a want 
of real knowledge, than in attempts to twist obvious 
facts to suit a particular theory ; but they had no- 
wish to appear conspicuous, except in their suc- 
cessful treatment of disease. I say it were well that 
we would again return to that simple path ; then, 
considering the many facts which we, from altera- 
tions in the state of society, possess beyond what 
was known in former times, we might render the 
mode of cure of such complaints, not, as is too of- 
ten the case, a jargon of inconsistent nonsense, but 
a system of well digested and well arranged doc- 
trines, demonstratively successful in their applica- 
tion. 

While some, I may remark, are affected with ve- 
nereal complaints, for instance, more frequently, as 
well as more severely, than others, where no visible 
cause seems to exist giving rise to such peculia- 
rity ; we find also, that some are more liable to be 
affected with one form ot the disease than with ano- 
ther. I may even observe, that I have known ma- 
ny gentlemen, who, although frequently exposed to 
the chances of such diseases, ha e escaped for ma- 
ny years without the slightest infection of any kind ; 
while others have scarcely ever committed a sin- 
gle act of indiscretion without suffering severely. 
In the cure of these affections, too, a certain degree 
of peculiarity exists in perhaps almost every one ; 
but in some so conspicuously, that the very nicest 
management is necessary, both in selecting and 
employing such remedies as will most certainly re- 
move the infection. I know, that inattention to 



138 

these points has often caused much unnecessary 
distress. 

There are also peculiarities of constitution, in 
which, though no visible cause can be assigned for 
it, there is the very greatest difficulty in curing 
such complaints, even independently of the most 
unremitting attention.' I have known various in- 
stances of this kind. In such persons, if affected 
with gonorrhoea, gleet was almost an inevitable 
consequence ; if with lues venerea, buboes were al- 
most an invariable and immediate consequence, 
which no degree of attention seemed capable of pre- 
venting from proceeding to suppuration. In such 
habits, too, I think I have remarked, that secondary 
symptoms were much oftener to be met with, than 
in those in whom these complaints were removeable 
in the common easy way. 

I have in other places, had occasion to remark, 
that in scrofulous habits, in particular, diseases of 
every description seem more difficult of cure, than 
in those in whom none of the symptoms of that 
disease can be traced. In the venereal disease, in 
whatever form it may present itself, the correctness 
of this remark must have appeared to all who are 
extensively employed in this line of business ; and it 
must often, as with myself, have baffled all their 
exertions, at least for weeks or even months. 
Moreover, were many venereal complaints not great- 
ly altered in their severity, by the particular state of 
the constitution at the time, their cure would even 
in all habits, be much easier than it is, and would 
thereby render the application of general and inva- 
riable rules for their removal less objectionable ; but 
this, all practical physicians, who attend to their 
profession, know is not the case. Although, 
therefore, general rules are most commonly applied, 
and sometimes with success, they ought only to be 
used under the observation ofone who can, if necessa- 
ry, vary the treatment, as circumstances may require. 



139 

In the cure of these complaints, I have, as form- 
erly stated, no purpose to effect by adhering to any 
particular hypothesis or theory. I endeavour to re- 
ly on observation, experience, and reason ; and, 
where these individually, or in combination, point out 
any doctrine which may, in a practical point of view, 
lead to a more successful mode of treating them, than 
I had hitherto been in the habit of employing, I ne- 
ver hesitate to lay aside that which greater and 
more extensive opportunities of observation and 
practice, either by myself or others, may convince 
me has been defective. I have always been of opi- 
nion, therefore, that it is chiefly a blind reliance on; 
and a determined adherence to, early acquired ha- 
bits and opinions, that has tended greatly to retard 
the improvement of every department of the me- 
dical profession. 

In proportion, then, as we became acquainted 
with the real nature of diseases in general, and con- 
sequently advance in our knowledge respecting the 
most judicious and best methods of curing them, 
we soon perceive the necessity of often applying 
our remedies more to the existing circumstances of 
the different stages of the complaint, than by- 
adopting any general rule of practice. Treating 
the disease throughout, for a certain number of 
days, upon one formal principle, and <a certain num- 
ber on another, which, although perhaps useful at 
one period of the disease, may be not only ineffi- 
cacious, but even hurtful at another, must at once 
appear improper. Yet the same mechanical plan as 
just noticed, is too generally persevered in, from the 
very first appearance of the symptoms, till they en- 
tirely either accidentally disappear, or, as in gonor- 
rhaea, till- they terminate in gleet or in lues venerea, 
in the most alarming state of confirmed pox. 

By adopting, however. :i greater share of scienti- 
fic discrimination, we not only free our patient from 



140 

much unnecessary suffering, but' we are also en- 
abled to reflect on our own propriety of practice, 
and on the right discharge of our duty, with some 
degree of comfort, which, otherwise influenced, we 
have no claim to. ' 

What merit can a medical man claim to himself, 
when, on stalking up to his patient, and finding him 
affected with chancre or with gonorrhoea, for in- 
stance, he at once, in the most general way, pre- 
scribes mercury, or injections ; and that without 
putting himself to the least trouble on the occasion, 
to know the particular circumstances respecting the 
patient's general health, mode of living, &c. or even 
the state of the existing symptoms ; according to 
which examination alone every rational physician 
will conduct himself: Every one, although pos- 
sessed of no knowledge of medicine, knows that in- 
jections often remove gonorrhoea, and mercury 
chancres ; the use therefore of a medical man, is 
not to assure them of these facts, but to point out 
the time, and under what circumstances they may 
or they may not be used. 



141 

CHAP. I. 

TREATMENT OP DISEASED URINARY ORGANS. 



Of Suppression, Retention, and Incontinence of 
Urine. 

While the secreting vessels in the kidneys conti- 
nue their healthy action, these organs, in conformity 
with all other operations of the animal fabric, per- 
form their proper and healthy functions. But when, 
from malconformation, external injury, or occasion- 
al disease, these functions are less or more deranged, 
the secretion of urine become partially, if not com- 
pletely altered, and sometimes ceases entirely. 

When these occurrences arise from malconfor- 
mation preventing the secretion of urine, the cure 
is not to be expected either from internal medi- 
cines or surgical operations. When also the dis- 
ease exists in consequence of external injury, caus- 
ing a partial or a complete derangement in the 
functions of the kidneys, or perhaps extensive ul- 
ceration of these organs, our chances of cure must 
greatly depend on the extent of such derangement. 
Our first object, under these circumstances, is to 
remove the exciting cause, and our other means of 
relief must be indicated by the existing circum- 
stances of the case, when this has been affected. 

As suppression, retention, and incontinence of 
urine, may all arise from, or exist, either in conse- 
quence of an inflammatory state of the system, or 
in the directly contrary state, — that of debility, our 



142 

first object, previous to our employment of any 
other mode of treatment, ought to be, to ascertain 
to which of these states the system inclines, and 
how far these diseases depend upon them. These 
points may, in general, be easily ascertained, by 
due attention paid to the appearance of the general 
habit, as well as to the state of the pulse, &c. This 
. being established, the plan of cure, so far as the 
disease depends on one or other of these states, is 
at once pointed out. 

In retention of urine from inflammation of the neck 
of the bladder, general blood-letting, if other cir- 
cumstances do not forbid such practice, is probably 
the best means of relieving it ; but if the patient be 
weakly, leeches may be used, and when the symp- 
toms have abated, a blister applied over the pubes 
will greatly assist in completing the cure. 
3 The warm bath, or gently sudorific medicines, will 

serve as our next order of remedies, with opiate 
glysters, frequently repeated. And on the pa- 
tient falling asleep, I have frequently found, that 
he discharged urine freely. I should therefore re- 
commend the free use of opiates, to procure at least, 
6 or 8 hours sleep in the 24, and its constipating 
effects may be removed, by mild cathartic medi- 
cines. The different states of the weather has a 
very great effect in rendering this complaint mild 
or severe. Patients, therefore, thus affected, ought 
to have the temperature of their chambers rather 
warm than otherwise, and as little subject to change 
as possible. If these means prove ineffectual, an 
artificial opening must be made into the bladder for 
the evacation of the urine. The puncture ought 
either to be made above the pubes, or through the 
rectum. I would prefer performing the operation 
in the last of these as, should the patient be corpu- 
lent, we have sometimes to cut a great depth before 
we can reach the bladder. 

When retention, however, arises from an imper- 
vious obstruction in the urethra, and if the bladder 



143 

is too much distended to admit of delay, we must 
at once make an opening in the manner just stated, 
and discharge it. After this, we must instantly re- 
move the obstructing cause. Perhaps, in this in- 
stance, from the necessity of dispatch, the instant 
removal of it by incision is preferable to any other 
method. A bougie being introduced into the ure- 
thra as far up as the stricture, we should make a 
small incision along the course of the urethra, and 
then, by cutting even upon the point of the bougie, 
make an opening for it; after having secured the 
opening along the urethra, we must adopt such 
measures as will most readily heal the external in- 
cision. 

The very mildest cathartics may occasionally 
be given, but none that will irritate the bladder, 
which is the case with a great variety of drastic 
purgatives. 

In slight debility of the fibres of the bladder, 
causing retention of urine, we, for the most part, 
may give considerable relief, after the catheter has 
been introduced into the bladder, by applying pres- 
sure or friction with the hand, or with a common 
flesh brush, so as to excite and occasion contraction 
of that viscus ; for without its contraction no urine 
will flow. At other times, however, the debility 
of that organ is so great, as to require, in combina- 
tion with the above, which is but of temporary be- 
nefit, much more active means in order to obtain 
lasting relief. 

In such a state of disease, nothing tends so much 
to remove the torpidity of the bladder, as the ju- 
dicious employment of tonic remedies, with, in al- 
most every case, the application of a blister over the 
sacrum ; and the remedy which I have found most 
useful, is the tincture of cantharides, in doses suf- 
ficiently great to affect the urinary passages. This 
state of action in the parts must be kept up for a 
length of time proportioned to the extent and se- 



144 

verity of the disease ; the removal of which may be 
known by the bladder resuming its natural func- 
tions, even after we have found it proper to give 
over the use of every kind of medicine. 

When the catheter, which in almost every case 
ought to be a large size, is to be introduced, the 
patient ought to be laid on his back, with his thighs 
gently opened, and his legs hanging over the side of 
the bed. The penis is grasped in the left hand 
of the operator, who rests on his right knee by the 
left side of the patient. The instrument is to be 
well oiled, and introduced with the .concave side 
toward the abdomen. If there be no morbid ob- 
structions in the urethra, it always passes freely 
forward till it arrives at the membranous portion of 
that canal, when, as the urethra here takes a slight 
turn, which often obstructs the catheter, it should 
be slightly withdrawn, the handle of it somewhat 
depressed, and then another attempt to push it for- 
ward generally succeeds. It is next apt to be ob- 
structed by the prostate gland ; but the same motion 
as above directed being made, the instrument slips 
into the bladder. 

When the spasmodic action of the parts exist, 
the directions to be given under the head of spas- 
modic stricture, must be applied here. 

Unless in this disease, the most active means are 
immediately used, sloughing of the parts with ex- 
travasation of urine, and even mortification ; will 
very rapidly ensue. Bleeding, blistering, and the 
free use of mild saline, purgatives, must therefore 
instantly be had recourse to, with the most rigid 
abstinence from every kind of exercise, stimulating 
or inflammatory liquors, or medicines. 

When these violent states of action of the system 
exist, which, if not removed by other means, re- 
quire the bladder to be punctured, we ought to be 
very brief in our proceedings, as the worst conse- 



145 

quences may ensue from the delay eve^n of an hour. 
If, therefore, on the appearance of this state, our 
remedies, which must be vigorously administered, 
do not effect our purpose as soon as their action 
should affect the general system, we ought instant- 
ly to have recourse to puncturing the bladder. 

In performing this operation above the pubes, a 
perpendicular incision is to be made through the 
integuments of the abdomen, at least two inches 
in length, immediately above the pubes. The part 
of the bladder, uncovered by the peritoneum, will 
then appear, into which a curved trocar is to be 
introduced, and when the stilet is withdrawn, the 
urine will flow. 

In performing this operation by the rectum, we 
must, in order to avoid wounding the vesiculae se- 
minales, introduce the finger its whole length into 
that canal ; a trocar having previously been laid on 
the forepart of the finger. The puncture must be 
made into the anterior part of the intestine, which 
is easily done, the parts being in general so thin, 
that even fluctuation of urine may be felt before in- 
troducing the trocar into the bladder. But, if we 
are not well acquainted with the structure of the 
parts, both in a state of health and disease, their 
natural situation may be greatly altered, and conse- 
quently may deceive us This may occur from tu- 
mors, thickening of the parts, or from diseased 
prostate gland. Previous^ therefore, to our per- 
forming this operation, we ought particularly to as- 
certain the exact state of the parts. 

When the bladder has burst, remedies are in- 
effectual. Even a rupture of the inner membrane, 
is perhaps beyond the power of surgery or medicine^ 
but its effects are not at least so immediately dan- 
gerous as the other. The states of that organ, 
which may be remedied by art, are those degrees of 
distension which it suffers, rendering it unfit to per« 












146 

form its healthy functions. If retention arises from 
this state, the urine must be drawn off by a ratheter 
or hollow bougie; and if the difficulty to introduce 
the bougie be greater than usual, we may allow the 
hollow bougie to remain in the bladder. 

When, from incontinence of urine, we have as- 
certained the nature of the disease, the state itself 
indicates the nature of the remedies which will re- 
move it If it arise from one or more of the parts 
immediately connected with the disease, having as- 
sumed anew action, such as complaint of the prostate 
gland, obstructions in the urethra, stone in the 
bladder, or other affections of the general system, 
our attention must first be directed to the removal of 
them. > If, however, it be alone caused by debility 
of the bladder, &c, stimulating medicines used 
internally, and applied externally, as cold bathing, 
stimulting liniaments, blistering the loins ; the 
internal use of bark, tincture of cantharides, &c, 
will generally effect a cure. 
^/ Respecting paralysis of the urethra, or rather of 

the sphincter vesicae, Mr Hunter observes, in page 
l66 of his book on venereal coin plaints, that " a 
man came into St George's Hospital with this 
complaint. I ordered him the before mentioned 
medicine, (cantharides) and it had such an effect 
as to bring on the contrary disease, or a spasmo- 
dic affection of the urethra, so that he could not 
mak^ water when he had an inclination ; but an 
injection of opium removed the complaint, and 
he was then well." 

When incontinence of urine exists in con- 
sequence of irreparable injury done to the parts 
in performing surgical operations, such as litho- 
tomy, &c, we must learn to accommodate our pa- 
tient to his inconvenient situation. In surgical 
booksj we shall find delineations of such instru- 
ments as are useful on these occasions, and these 
■j* must'too frequently be used during life. 



147 

CHAP II. 

TREATMENT OP MALE ORGANS. 



Of Seminal Emission. 

It is absolutely necessary to a scientifice treat* 
merit of every complaint, first to ascertain its causes, 
its effects on the parts immediately concerned, and 
also those which it produces on the general system. 
The difficulty of being able to ascertain these, is * 

sometimes great ; but it is possible to do so, in per- 
haps every instance, and then their removal becomes 
comparatively an easy task. In seminal emission, 
this has been much overlooked, and consequently its 
cure has been deemed impossible. But if we had 
considered the great debility induced on the parts* 
by the overaction which frequently was artificially 
induced before the complaint was constituted, and % 
then the consequent debility of the whole system 
which ensued, we only require to know what re- 
medy will restore them to their healthy action. 
The cantharides, in a very extensive range of prac- 
tice, have never with me failed in the removal even 
of the worst cases ; and I, therefore, with the ut- Vj 
most confidence, recommend it to the attention of 
others. 

Jf this complaint arises, which in almost every 
case it does, from excess of venery, or from self pol- 
lution, the first and most important advice the pa- \ 
tient can receive, is to refrain from these habits. 






>*=>- 



148 

For, while these are perserved in, no method of cure 
can be effectual. 

In other respects, the medical practitioner's ad- 
vice must, no doubt, be dictated by the state of his 
patient. No disease, however, has been more un- 
derstood, or worse treated in general, than this. 

Medical men, influenced in their conduct by the 
notion, that the venereal appetite arises from a vi- 
gorous, and, as it were, an inflammatory state of the 
system, and that, whatever excites or promotes its 
activity, aggravates these desires, enjoin abstinence 
from animal food, from ardent spirits, from every 
thing, in short, which they suppose can heat the 
body, of excite the circulating powers. 

This reasoning is certainly just, when applied to 
individuals in the flower of health, and vigour of 
youth ; but it is very erroneous when applied to 
those whose bodies are exhausted, enfeebled, ill- 
nourished. It is here a disease of habit and de- 
praved mind, not excited by repletion and supera- 
bundant vigour. Here the almost exhausted pow- 
ers are to be invigorated, debility to be obviated, 
the body to be nourished) the mind to be rendered 
cheerful. Are these objects to be accomplished by ' 
abstinence from' every thing which contains the 
principles of activity, or of supply for the animal 
machine ? 

It was impossible that such a practice could ever 
be successful ; and hence it is, that the triumph of 
empiricism over regular practice has never been so 
great as in this complaint ; because the empirical 
medicines contain active substances, which patients 
find useful to them when the other means have 
failed, or are even hurtful 

I venture to affirm, that the means which are most 
beneficial in such cases, are nourishing diet, moderate 
use of wine, animal jellies, certain kinds of bodily ex- 
erci e, increased a cording to the return of the pa- 
tient s strength : opium, musk, assafcetida, camphor, 



14t) 

occasionally, to procure sleep, aleviate spasmodic 
symptoms, and calm the apprehensions of the mind, 
together with such means as shall be best suited 
to keep the bowels regular, and restore soundness 
to the organs of urine and generation. 
jr Repeated erection in the night, and copious dis- 
charge of semen, in consequence of dreams, though 
the individual is not addicted to any blameable 
practices, is not an uncommon disease ; and to this 
form of complaint, the reasoning which was erron- 
eous, and led to hurtful practices in the former, 
will apply with propriety. 

Spare diet, cold bathing, frequent ablution of the 
parts in cold water, sleeping in a cool chamber with 
few bed cloaths, and not too foft a bed, some busi- 
ness that will arrest the attention, &c, are here to 
be advised. 

From a long continuance of that state of the 
parts which causes seminal emission, the internal . 
lining of the urethra becomes so completely diseas- 
ed as to the prevent its ever again resuming its 
healthy actions. While in this state, it must act 
as a foreign substance applied to the parts, and 
greatly increase the disease. I have always observ- 
ed that, in this state of the parts, such cases of se- 
minal emission as have come under my observation, 
have been longer of being removed, than under any 
other circumstances. Months have often elapsed 
and, independently of the very greatest attention 
on my part, these symptoms have not in the least 
degree relaxed, but, on a quantity seemingly of 
membranous substance being voided along with the 
urine, the severity of the symptoms gradually abat- 
ed, and the parts completely recovered. 

The severity of a complaint is but a relative, and • 
at best a vague term ? hence authors, having no- 
thing to compare their meaning by, when they -'em- 
ployed such a phrase, were vtry apt to consider it 
/ severe or otherwise, according only to their particu-. 



fL-** 



K 3 



150 

lar success, not according to the extent of the com- 
plaint itself. Thus we have seminal emissions, said 
to be of the very worst kind, cured by medicines 
extremely trifling and inefficacious. It is scarcely 
possible that the relaters of such cases could state 
what did not really happen, but the indefinite man- 
ner of considering such complaints must have led 
to the mistake. 

In seminal emission or impotence, then, the most 
erroneous practice has always been followed, because, 
as formerly stated, medical men really did not seem 
to understand the nature of the disease, and their 
practical doctrines were consequently fraught with 
the grossest error. They found it necessary to say 
something on the subject, and, as in almost all 
other guessed works, they stumbled on error : yet, 
strange to tell, they gave detailed cases of their 
success, with as great a degree of gravity as if they 
had actually been successful. 

The common, and indeed all remedies then re- 
commended even by the the most respectable wri- 
ters, from their thus evidently having entertained the 
most erroneous notions respecting the nature of the 
disease, were at least ineffectual. Mr Hunter's 
sole dependence was from the effect of opium, bark, 
valerian, musk, camphor, and the cold, and some- 
times warm bath, individually used as he deemed it 
proper. In the very slightest cases, these substan- 
ces might probably prove of some service, but, in 
more severe affections of this sort, they might be 
used in any quantity, and for any length of time, 
till they destroyed the digestive organs, but they 
never could relieve the disease. 

On account of the disordered state of the diges- 
tive organs which almost always accompanies this 
disease, it is necessary that the food and drink of 
the patient should be such as to contain much 
nourishment in small volume, and such as are easily 
digested. Salted or high seasoned food do not come 



151 

under this description, and are therefore, in an es- 
pecial manner to be avoided. Indeed every sort of 
food, particularly animal food, must be avoided at 
supper, before going to bed. 

While there are perhaps no complaints to which 
the human body is liable, which are, in certain 
states, so tedious of cure, it is a fortunate circum- 
stance, that the principal medicine by which such 
diseases are removed, can, under proper regulations, 
be taken to any extent, or for any length of time, 
and even then with the most beneficial effects. 
No instance, indeed, of such complaints, uncom- 
bined with any other, has yet come under my 
observation, which has not, by patient persever- 
ance, been completely and permanently remov- 
ed. In this particular point, the cantharides dif- 
fer from every other medicine with which I am 
acquainted. All other substances lose their effects 
by use, and, if we expect good effects to arise from 
them, must be increased in proportion to the time 
they are used, while they at the same time assist, 
in a greater or less degree, in injuring the consti- 
tution of the person who employs them. Canthari- 
des, on the contrary, improve every faculty, both 
of body and mind, the longer we employ them, 
while, instead of increasing their doses, we are ac- 
tually obliged to decrease them, and that often 
from the largest to the very smallest quantity that 
can be used. 

As, from the alterations in the functions of the 
parts, under the use of the cantharides, from dis- 
eased to healthy action, the emissions may even be 
reproduced by the stimulating effect of that medicine, 
we have reason rather to be pleased than otherwise, 
at such an event arising from such a "cause. I have 
several times in practice met with this circumstance, 
and have uniformly found, that then the opportuni- 
ty of abandoning the medicine was at no great dis- 
tance. When great irritation (for it is in this stage 
k 4 



* 



152 

only, that irritation is produced by the cantharides) 
occurs almost every time the medicine affects the 
urinary organs, and that probably accompanied by 
an emission, then we must begin rapidly to dimin- 
ish the doses. After this, it is not always ne- 
eessary to have recourse to the medicine again ; 
but, if it should be so, the patient's own feelings of 
debility must convince us of the propriety of such 
a measure. At this period, if such steps should be 
necessary, that propensity to gloominess of mind, 
so commonly present in such complaints, and so 
apt to overpower the patient, is likely to return. 
This we ought, if possible, to prevent, as then it is 
only necessary to take the medicine one week, 
and to omit it T the following one, during a few 
months, in order to insure him of the most perfect 
recovery. Even were it found necessary to use 
the medicine during the remainder of the patient's 
life, a circumstance which I never yet met with, 
it can produce no bad effects, and would certainly 
be much less troublesome than the presence of 
the complaint for the removal of which it was em- 
ployed. 

CASE. 

A Gentleman, aged 40, stout, and of a dark 
complexion, several years ago contracted a gonor- 
rhoea, which was removed by injections, contain- 
ing acet. plumbi in solution. Soon after the re- 
moval of the discharge, he felt great debility of the 
parts of generation, and very seldom had any in- 
clination to the fair sex. It was not till after two 
years and a half, that he began to recover his wont- 
ed vigour, when he again had the misfortune to con- 
tract a gonorrhoea ; this too was cured by injections, 
containing acet. plumbi. Immediately after the re- 
moval of the discharge, all the symptoms of his 
former weakness affected him, and he repeatedly 

(L&dcf A 



153 

observed great quantities of scaly membranous sub- 
stances floating in his urine, unaccompanied, how- 
ever, by any gleety discharge. 

When he informed me of the above circumstances, 
in addition to his other complaints he mentioned, 
that for two months previous he had frequently, 
while in bed, been affected with involuntary emis- 
sions of semen. After these occurrences, the 
stream of his urine was undiminished in size ; and 
I now prescribed for him, tinct. cantharid. sfs, aq. 
fount. 3vi, a table spoonful to be taken four times 
a- day. 

Two days after, he observed a drop of blood at 
the external orifice of the urt- thra, but experienced 
no pain or uneasiness from taking the medicine, 
and in two days more, the membranous substances 
formerly mentioned were not so plentiful as at 
first. 1 therefore desired him to continue the can- 
tharides. 

For two months he persevered in the use of that 
medicine, in sufficient doses to produce slight dif- 
ficulty in voiding urine. During this time, the se- 
minal emissions gradually became less frequent, 
and the scaly substances, which he voided with his 
urine, changed from white to a yellowish colour, 
but did not diminish in quantity. 

As I was obliged to be in London about two months 
after, I left instructions with my patient, on whose 
accuracy I could depend, to continue the tincture 
in doses similar to what he had been accustomed 
to, and to use the cold bath thrice a week. 

"On my return, about six weeks after, he inform- 
ed me, that he had continued the cantharides regu- 
larly, till within the last ten days; and as he had, 
previously to that period, experienced the most be- 
neficial changes in his health, I declined giving 
him more of it. The scaly substances had now 
completely disappeared, and for the last six weeks, 
he had only two seminal emissions. I, however, 



154 

desired him to continue sen-bathing while the wea- 
ther was tavouisnie 

In September i80g, he had experienced no re- 
turn of his complaints, and his general health was 
mcuh better than it had been from the commence- 
ment. 

CASE 

On the 12th of January, a gentlemen aged 28, 
complained of great general debility, with acute 
pains in his loins, occasionally darting down his 
thighs. For fourteen years he had been subject to 
wet dreams, from improper practices, sometimes re- 
turning almost every night. He never had, how- 
ever, any gleet discharge or venereal complaint ; 
never having had a connection with any female. 
His attempts of this kind were attended with such 
immediate embarassments, as might be expected, 
producing the usual despondency of mind. 

These emissions usually occurred during the 
night, while he was in bed, and were followed by 
a disagreeable burning heat all over the body, with 
great anxiety and heaviness, but a complete inabi- 
lity to sleep during the remainder of the night. 
He, however, passed his urine in a full stream. 

I ordered him to substitute for the soft bed, to 
which he had been accustomed, a hard matrass, 
to use few bed cloathes, and to sleep in a well venti- 
lated bed chamber. I likewise prescribed nounsh- 
tf ing diet, with two or three glasses of wine after 
dinner, and tinct. cantharid. aq. font, of each %lj 
Two tea-spoonfuls to be taken thrice a day in a glass 
of water. 

On the 13th, he was affected with considerable 
pain and difficulty in voiding urine. I therefore 
ordered the cantharides to be taken in smaller 
doses. 

On the 16th, he had taken the cantharides in 

C4* %A ^Lfr«-iM- 



155 

sufficient doses to keep up a slight degree of unea- 
siness in the urethra, but had nevertheless an emis- 
sion last night while in bed. I ordered the can- 
tharides still to be continued. 

Oo the 20th, he had another emission. These, 
however, were less frequent than before the use of 
the cantharides. 

On the 2»st, he had another emission, after 
which, however, the burning heat, &c. over his 
body did not trouble him. The cantharides were 
therefore still continued. 

On the 6th of February, he continued to take 
the cantharides in sufficient doses to keep the parts 
uneasy, and till the morning of this day, had no 
emission since the 22d ult., and even it was not at- 
tended by the disagreeable symptoms above describ- 
ed. The cantharides, therefore, were still conti- 
nued. 

On the 7th, he had another emission. And 
since he began to use the cantharides, he had ob- 
served, that it was not till two or three days af- 
ter an emission, that the medicine again produced 
its usual effects on the urinary organs. The emis- 
sions, however, were now of rare occurrence, and 
he felt stronger and in better health than he had 
done for several years past. The pain in his back 
had greatly abated. I still ordered the cantharides 
to be continued. 

On the 1st April, the emissions since last report, 
had occured about once a week, and he thought 
they were now most frequent when he happened to 
take an over dose of the cantharides. I, however, 
desired him to use the cold bath twice a week, and 
to continue the cantharides. 

On the 26ih, the emission also continued once 
a week, but were unattended by the disagreeable 
sensations which formerly accompanied them. 
Although his general health was very considerably 
improved, he began now, from the length of time 



150 

which had elapsed since he expected relief from the 
cant baridfS, to be anxious abovit his complaints, 
and almost completely to despair of ever being >^ 
cured of them. I ordered the cantharides still to 
be continued. 

On the *th of May, the emissions had, for ten days \j| 
past, been more frequent than usual. I began to 
suspect that he occasionally recurred to the origin- 
al cause of his disease, and hinted to him, that with 
such habits he could never expect to be complete- 
ly cured He was rather offended at my suspicions, 
and positively assured me, that in those suspicions 
I did not do him justice. I thought it right, 
however, to impress his mind very strongly on the 
occasion. 

I did not see my patient till the first of June, 
when he again assured me that my suspicions were 
erroneous ; that he was now much better, having 
had no return for a fortnight past. This agreeable 
change, however, I attributed to my remonstrance, 
and ordered the cantharides, &c. to be still conti- 
nued. 

This patient now went to sea bathing quarters, 
and I did not see him again for nearly three months, 
when he told me, that his complaints, during that 
period, had become worse ; but he confessed, that 
he had used the cantharides, &c. rather irregularly 
for sometime past. I then represented to him the 
danger attending the long continuance of such 
complaints, which alarmed him much, and he pro- 
mised to be very attentive in future ; and, by the 
closest attention to the rules laid down to him, tf 
he informed me, about the beginning of Novem- v 
ber, that his former complaint had returned only 
about once a month. By the end of the year, he 
had completely recovered, and had even become re- 
markably stout. 



", 



157 



CASE 
i 

January 4th, a gentleman, aged 22, stout 
mzvie, but considerably emaciated, was, about two 
years ago, (probably from the same cause as in 
the last case), suddenly affected with the same in- 
convenience, sometimes thrice in the course of one 
night, attended with an uncommon desire to vene- 
ry. Since the commencement of these emissions, 
he had been affected with gonorrhoea, which was 
soon cured by the use of injections. This original 
complaint, however, did not seem in the least af- 
fected by the gonorrhoea, as it continued exactly 
in the same degree after that disease had left him. 

Palpitation of the heart, and almost constant 
ringing in the ears, had of late troubled him very 
much. He suffered no pain; his mind, however, 
was in the greatest state of despondence, and his 
life was actually become a burden to him. He was 
at last distressed by the most dreadful dreams, 
which rendered him melancholy for several clays 
after. They were principally respecting the death 
of some of his nearest relations ; and although he 
was not at all superstitious, he could not prevent 
his mind being thus affected by them. What as- 
tonished him very much was, that he often dream- 
ed, that he himself was about to expire in the arms 
of his relations ; and once or twice he actually 
thought he had quitted this life. He gradually be- 
came very Stupid, and unable to apply his mind to 
any employment, but was quite sensible of his be- 
ing in that state, and for sometime past his feelings 
had become morbidly acute, which, if possible, aug- 
mented his affliction 

To these symptoms were added, about a year 
ago, general weakness, with most distressing pains 
in his back ; and, for si.i months past, he had expe- 
rienced sudden giddiness, and a sort of faintness, 



158 

during which, objects of various colours seemed to 
float in the air before him ; and this was immedi- 
ately succeeded by perspiration all over his body. 

He was, about the time I saw him, frequently af- 
fected with cold sweats over his body, coldness in 
his feet and hands, with a great degree of coldness 
in his generative organs. For the last three months 
he had, almost every night, been troubled with very 
painful erections, but without his former desire for 
venery, which often kept him awake the Whole 
night. He was now affected with a slight tickling 
cough, with pains in his breast ; but his expectora- 
tion was not very copious, though of a blackish 
colour. Every attempt at connection had, for se- 
veral months, been instantly attended with an emis- 
sion, and he had uniformly observed, that if at any 
time the emission did not occur for a few days, 
that next time they appeared, the semen was great- 
ly encreased in quantity to what it was on other 
occasions, and continued to be so for two or three 
days. 

A celebrated surgeon* to whom he applied, had 
recommended strong doses of physic, and daily co- 
pulation, which he assured the patient, would les- 
sen the emissions ! I prescribed tinct. canth. 3j, 
aq. font. jvii, a table spoonful to be taken thrice 
a day, and the doses to be gradually encreased. 

On the 5th, he experienced great pain in void- 
ing urine, which continued to encrease in severity 
during the day. He therefore left off the medicine, 
and before night this symptom had abated. 

On the 6th, I desired him to take the canthari- 
des as recommended on the 4th. 

On the 9th, he had no return of the pain, al- 
though he had now taken the canthandes in in- 
creased doses. Since he began the use of this me- 
dicine, he slept much better than formerly, and had 
almost constantly felt a strange sort of prickling 



159 

ling sensation all over his body. I have ordered 
the cantharides to be continued. 

On the 14th. he had suffered very little pain 
from the last report, and ever since he had began 
the use of that medicine, he had no emissions. 
He, however, almost every night, felt as if the 
emission was just coming on, though it did not. I 
therefore ordered the cantharides still to be conti- 
nued, with half a pint of wine per diem, and the li- 
beral use of porter. 

On the 16th he complained, that general debi- 
lity had again recurred, but he had no return of the 
emissions. I therefore ordered the cantharides, &c. 
to be continued still. 

On the 18th, he accounted for the above symp- 
toms, from his having exposed himself to damp- 
ness for a considerable number of hours. The can- 
tharides, &c were still continued. 

On the 23d, he had an emission while in bed, 
but that had not in the least distressed or even 
roused him from his sleep, as he did not know of 
it till morning. His general health was not much 
improved. The cantharides were still continued. 

On the 1st, of February, he had no return of the 
emission, and from the changes that had taken 
place in his health, he was in very high spirits. 
He was now stout, and able to walk a number of 
miles without being fatigued, which formerly he 
could not do. The cantharides were still conti- 
nued. 

On the 6th he had, for two days, suffered very 
considerable pain from the cantharides, and during 
the previous night, while in bed, he had two emis- 
sions, which depressed his spirits considerably ; and 
on the night of the 7 th he had another. 

On the 8th, when he informed me of the above 
occurrences, he likewise mentioned, that the giddi- 
ness and dimness of sight had returned ; the pain 



]6o 

from the eantharides had however abated, and I 
therefore desired him to encrease the doses. 

On the Iftth, for several hours, the pain from the 
eantharides had been very severe, and during it he 
an emission. He uniformly remarked, that he had 
had, in rapid succession, one or more emissions when 
the eantharides affected him severely. These emis- 
sions, however, were not now accompanied by these 
troublesome sensations which formerly attended 
them ; and his appearance was much improved, ha- 
ving lately become much stouter than usual. Nor 
was he so apprehensive as formerly, and the gene- 
ral gloomy state of his mind was entirely removed. 
The eantharides were still continued. 

On the 1 llh of March, he had, since last report, 
only one emission, which did not distress him in 
the slightest degree. He had now become very 
stout, and was, in every respect, in a state of good 
health. I however desired him to continue the 
eantharides in moderate doses, and to use the cold 
sea-bathing during the summer season 

In September 180g, he contiuued entirely free 
from his complaints. 

CASE 

A GENfLEiviAfr, aged 20, apparently stout, was 
about years ago, while at school, initiated in bane- 
ful practices. It Was not till after three years con- 
tinuance in these habits, that he felt the least in- 
convenience arising from them. Then, however, 
he was suddenly affected with frequent emissions 
while in bed ; but as they proved only troublesome 
for the moment, he was not in the least degree 
intimidated by them, and for a year after, he conti- 
nued his habits more frequently than ever. About 
two years ago, these involuntary emissions became 
more frequent, troubling him four and often sifc 
times every week. These were now followed by 



161 

cold shiverings, which lasted for an hour or two 
each time, with complete inability to sleep during 
the remainder of the night. He was n^w also af- 
fected with frequent cold perspiration all over his 
his body, with coldness of his extremities, with 
shrinking of his generative organs, and gr< at pain 
of his stomach ; sometimes with a voracious appe'ite 
for food, but more frequently a disgust to all vic- 
tuals for several days. On such occasions, if 
he swallowed any thing but liquids, the sens'tions 
he felt in his stomach were not actually painUiI, 
but indescribably irksome. From the difficulty, too, 
which he felt in being obliged to perform the act 
ofjrespiration^almost entirely by his voluntary pqw- 
ers, he believed he should die suddenly while in 
bed. About that time, he felt an irregular swelling 
in one of his testicles ; and he began, for the first 
time, to suspect the real cause of his complaint. 
To prevent his relations from becoming acquainted 
with it, he exerted his ingenuity to prevent them 
from applying for medical assistance He at first 
thought, that, by abstaining from his former prac- 
tices, which he now resolved to do, he should reco- 
ver without being obliged to have recourse to any 
other expedient, but this would not do ; for now, 
in addition to his other distresses, his bowels be- 
came obstinately costive, and he could procure no 
evacuation, without the assistance of cathartic me- 
dicines. These, with the cold bath, and the inter- 
nal use of bark and wine, and occasional 1) mineral 
waters, were the only medicines he used, till he ap- 
plied to me. 

He assured me, that he had nothing to accuse 
himself of for about two years. His eyes, however, 
seemed dull, and he complained of partial blind- 
ness, particularly for an hour or two after he had 
an emission, which happened from four to six times 
every week. He had no gleety discharge, nor had 
L 



162 

be ever in any form been affected with a venereal 
complaint. He complained of an almost constant 
dull pain in bis back, and in his stomach, and an 
uneasy sensation in the left testicle, which he in- 
formed me had swelled considerably for two years. 
On examination, I found that this was a very con- 
siderable enlargement of the convolutions of the 
epididymis, and also of the spermatic chord ; but 
as the pain from it was inconsiderable, it gave him 
no alarm. His bowels were still in a state of great 
torpidity, so that, without the exhibition of a ca- 
thartic, he was unable to procure an evacuation ; 
and if he omitted the liberal use of bark and wine, 
his food, for several hours after taking it, produced 
the most uneasy sensations in his stomach ; and, 
on such occasions, he had most excruciating pains 
in his heao\_ 

On the 20th of December, I prescribed for him 
tinct. cantharid. ^fs, aq. font, jvii, — a table-spoonful 
to be taken four times a day. 

On the 23d I repeated the mixture, and with it 
the following powder, as, after every dose of the 
cantharides, pain and uneasiness about his stomach 
became very troublesome, l^. carb. ferri, Bi, zinzib. 
alb. 9i, cort. per. si m. A tea spoonful to be taken 
thrice a day in a little w T ater or wine. 

Before a week had elapsed, he felt slight diffi- 
culty in voiding urine, but the pain in his stomach 
was not nearly so troublesome as before the exhibi- 
tion of the powder. He remarked, that all tonics, 
particularly of the mineral kind, had uniformly 
agreed with his stomach, and he thought he had 
derived partial relief from the internal use of such 
mineral waters as are to be found in the neighbour- 
hoodofthis city. Emissions, however, still continued 
as formerly. On account of the pain in his stomach, 
I desired him to take chamomile tea, instead of 
common tea, for breakfast, and animal jellies instead 
»f animal food, for dinner ; with occasionally a lax- 



103 

ative pill, composed of equal parts of extract of hy- 
ociamus and aloes In this way he continued till 
the end of January, before he was sensible of any 
change in his complaints, and even then, there was 
only an abatement of those very distressing sensa- 
tions, which invariably had followed the emissions, 
but no alteration in the frequency of their returns. 

On the 1st of February, the pains in his stomach 
were, immediately after the use of the tincture, very 
troublesome, t therefore desired him to omit it en- 
tirely, and, in addition to the other articles of diet, 
to use nearly a pint of port wine per diem, and, in- 
stead of eating at the stated periods, to take a small 
quantity of animal jelly, or nourishing soups, every 
two hours ; but never to take either of them in 
such quantity at once 4 as to satiate his appetite for 
food. 

On the 25th, having suffered ho pain in his sto- 
mach for about If) or 17 days, he recommenced 
the use of the tincture in small doses, and his other 
articles of food. &c were continued as formerly, 
with the addition of the cold bath every morning. 
By the 1 2th of April, gradually augmenting the doses, 
he could take about three drachms per diem of the 
tincture, which did not occasion any pain in his 
Stomach, but kept up a constant degree of irritation 
in the urinary organs. The emissions did not now 
occur oftener than once, sometimes twice a week ; 
and no disagreeable sensation was felt after them 
when they did occur. His bowels became much 
more regular than formerly, and he only required 
one of the laxative pills every two or three days, in- 
stead of one every day. 

On the lath of May, he again felt severe pains 
in his stomach, immediately after taking a dose of 
the tincture, in consequence of which I desired 
him to diminish the doses ; but the pain being still 
produced, he was ordered to discontinue the use of 
the tincture entirely. I remonstrated with him on, 
L2 



104 

the impropriety and even danger of indulging in 
former practices, but he assured me that he did 
not ; as his anxiety to be relieved of his complaints 
was very great. I attempted twice or thrice to re- 
commence the use of the tincture, but even the 
smallest doses produced pain in his stomach ; and 
he now observed, that almost immediately after 
taking a dose, he had an emission. 

On the 1st of June, I therefore omitted the tincture, 
and gave him a saturated solution of phosphorus in 
jether *, with directions to take two drops in a glass 
of water thrice a day. He once or twice added one 
drop to the dose more than he was desired to take; 
but from the disagreeable sensations which he felt 
in his head, immediately after taking it, he did not 
in future feel much inclined to deviate from the 
the rules laid down to him, but, with the greatest 
care and attention, continued to increase the doses 
till the 20th, when he told me that the emissions 
were now not oftener than once a week. I desired 
him to continue the solution, gradually increasing 
the dose. 

In October following, this gentleman had enjoy- 
ed much better health than he had done for about 
three years past ; his appetite for food was oiore 
regular, and the state of his bowels more natural ; 
his sleep was undisturbed by frightful dreams, and 
the emissions occurred only once a week, and were 
unattended by the sensations formerly so distressing 
to him. I desired him to continue the medicine a 
few weeks longer. 

On the 2d of June in the succeeding year, I was 
glad to be informed by my patient, that although 
the swelling in the spermatic chord still continued, 



* I have, for some years, been in the habit of prescribing this 
very active medicine in paralytic affections, and in certain diseases 
of debility, with very flattering promises of success. See the case 
near the end of this work. 



165 

yet his health was good, and he was capable of ex- 
ercising all his functions, and seldom had an emis- 
sion. 

In September I8O9, this patient continued in 
perfect health. 

CASE. 

A gentleman, aged 23, when about 1 2 years of 
age, fell prematurely into bad habits. About six 
months after the commencement of these prac- 
tices, he felt very disagreeable sensations about his 
generative organs. This was not an acute pain, 
but a sensation, as it were, of something trickling 
about his perineum and testicles. Soon after this, 
he experienced great pains shooting along the in- 
side of the thighs, and from time to time, a sharp 
stinging pain darting along the penis. To these 
were added, incontinence of urine, which, as it 
was passing, and for a few minutes after, caused a 
burning sensation, with a sense of fullness about 
the glans penis. At this time, he had frequent 
cold shiverings, and great restlessness during the 
day, and inability to sleep during the night, in 
consequence of being troubled by the most fright- 
ful dreams, the recollection of which, even while 
he was awake, terrified him. In this situation he 
continued two years, when, in addition to the above 
complaints, he had frequent involuntary seminal 
emissions. An extensive ulcer, too, broke out on 
the penis, which was healed up in a few weeks by 
simple dressings. His urine at that time became 
very turbid and extremely foetid. The night dis- 
charges continued to increase in frequency, and 
abput a year after their commencement, he was af- 
fected with severe pains in the back and stomach, 
which spread to the intestinal canal, and he became 
very costive. Laterly these sensations had affected 
every part of his body, rendering even the friction 
L3 



166 

of his wearing apparel painful to him. The great 
debility he now laboured under, was indescribable, 
and the semen actually run from him on using the 
slightest motion. He was advised to use sea bath- 
ing, (a very common advice with medical men, 
when complaints are likely to baffle them), but 
from this he derived no benefit; even while making 
the exertion necessary in swimming, seminal emis- 
sions distressed him, and this was immediately foU 
lowed by cold shiverings and most distressing debility. 
The glans penis was swelled to an enormous size, 
and the preputium was pushed behind it. This con- 
tinued several months when the swelling began gra- 
dually to abate, but the prepuce never returned to 
its natural situation. This was soon succeeded by 
a continual perspiration all round the sacrum, and 
the parts immediately in its neighbourhood ; and 
soon afterwards, he experienced most excruciating 
pains in all the lumbar vertebrae, which were follow- 
ed by an evident distortion of these bones. General 
emaciation, to a great degree, soon followed, and 
inflammation again affected the penis, but much 
more generally than on the former occasion. It 
however only continued a short time, when it dis- 
appeared spontaneously. An intolerably foetid dis- 
charge, of a yellowish colour, now proceeded from 
the corona glandis, and he applied to a surgeon, 
who told him that his disease was venereal, and 
prescribed for him a course of mercury. From this 
he derived no advantage, although he continued to 
use it several weeks. He was then informed by 
his medical attendant, that his complaint was gravel, 
and was advised to use sea bathing for its removal. 
His penis and testicles now shrunk very considerably, 
and were drawn up so close to theabdomen, as scarce- 
ly either to be seen or felt. Soon afterwards, how- 
ever, his testicles and scrotum swelled prodigiously, 
and ever since that time, the convolutions of the 



167 

epididymus have been enlarged, and distinctly felt 
through the scrotum. 

For several years past, most of the above com- 
plaints have been stationary. By degrees, however, 
his mind partook of the general disorder ; he be- 
came very timorous, and the least alarm threw him 
into great agitation. He became extremely weak, 
and quite incapable of following any occupation : 
and night sweats, with difficulty of breathing, horse- 
ness, and cough, prevented him from sleeping even 
when he became drowsy. Great depression of 
spirits, with languor, dimness of sight, tingling in 
the ears, and continual horror of mind, had, for sev- 
eral years past been gradually added to his other 
complaints, which, when I first saw him, had ren- 
dered his life a great burthen to him, 

I prescribed for him twenty drops of the tincture 
of cantharides, to be taken in a glass of water, four 
times a day. He gradually increased the dose, and 
at the end of four weeks, he was taking half an 
ounce of the tincture daily, when it, for the first 
time, occassioned him considerable pain in passing 
water. Being three or four miles distant, I did not 
see him when this sensation was first produced, 
and continuing to take the medicine in the same 
quantity, the pain occasioned was of course very 
severe. For two or three days, about that time, 
he passed water involuntarily, and an almost con- 
stant profuse perspiration pervaded his whole skin. 
I desired him to give up the use of the medicine 
for a few days, to apply warm, clothes to the lower 
part of his belly, and to take a smart purgative. 
In a few days these uneasy symptoms disappeared, 
and I desired him to recommence the tincture in 
very small doses. 

With the usual cautions which I have elsewhere 

recommended, he continued to use the tincture, 

sometimes in larger, sometimes in smaller doses ; 

and in less than three months from the time he be- 

L 4 



168 

gan to use the medicine, he became much stronger, 
took bis food better, and some of his numerous 
complaints had entirely disappeared. Even at this 
cold season of the year, (January,) I desired him 
to use the cold bath, which, in addition to the 
former prescriptions, he continued to do with the 
greatest advantage. I desired him likewise to take 
hall a pint ot wine ever) day, and to live on good 
nourisbini diet Under the properly regulated 
management of these prescriptions, he recovered 
from his complaints by *lo\v degrees, and he was, 
in Julv following stout and active; and, but for 
that general gloom which his former state of body 
Seems to have entailed on him, he has no com- 
plaint. I have desired him to decrease the doses 
of the cantharides by slow degrees, and to con- 
tinue- the cold sea-bathing for the remainder of the 
season. 

In October J8O9, although the spermatic chord 
of this patient still remained enlarged, and he had 
occasional emissions, yet even these were so rare 
as not to constitute disease. 

CASE 

An unmarried gentleman, aged 30, was addicted 
to private indiscretion at so very early a period, that 
from secretion of semen not subs* qnently taking 
place he could not procure an emission ; but being 
ignorant of the bad consequence of such practices, 
he continued this habit to excess for a considerable 
length of time The first bad effects of these prac- 
tice^ which he did not then attribute to that cause, 
was frequent giddiness, attended with a sensation 
as if the earth, as he expressed himself, was sink- 
ing under him. Still, however, he did not refrain 
from his bad habits, and of course these symptoms 
gained ground. To these symptoms were added 
others; he became peipetually apprehensive and 



i6g 

alarmed, he knew not for what, on the most trifling 
occasions ; was almost constantly troubled with 
violent palpitation of his heart, with stinging or 
shooting pains across his chest, and on such oc- 
casions he experienced flushing of the face, and a 
most disagreeable heat all over his body, particu- 
larly in the palms of the hands, and soles of his 
feet. His testicles now hung lower than usual, par- 
ticularly the left, and the spermatic chord was some- 
what enlarged, and very painful. His mind now 
seemed to partake of the general disorder, he be- 
came awkward and stupid to a great degree ; all his 
mental faculties suffered considerably, especially 
his memory, which, unless on very particular sub- 
jects, and these of the very simplest nature, almost 
entirely left him. He laboured under a continual ap- 
prehension, that at some period at no great distance, 
he would altogether lose his reason. What ren- 
dered his situation particularly distressing, was his 
being perfectly sensible of all his distresses, and of 
all his mental depravations as now related. He at 
length bt-came greatly alarmed for his safety, and 
was in continual fear that he would expire suddenly 
when in bed. It was not till this period, which was 
his '22d year, that he resolved to lay aside all those 
bad practices which he now concluded must have 
given origin to his present state. Soon after this, 
he first had connection with a female, and this he 
repeated in moderation for a considerable length 
of time. He was now sensible of a great improve- 
ment in his health, the palpitation of his heart 
ceased, and he became somewhat cheerful in com- 
pany ; but still his mind was weak, unsettled, and so 
easily agitated, that it alone threw a damp on all the 
pleasures of life. 

From his 2%d till he arrived at his '26th year, he 
occasionally used cold bathing, which he thonght 
yielded him momentary n.hef, but produced no 
permanent good effect on his health. He at length, 



170 

however, found that he had no inclination for sexual 
intercourse, nor were his powers in that way so 
vigorous as they had been for some time before. 
He now tried the effect of nourishing diet, and re- 
gularly used mineral waters for two seasons, which 
he thought of advantage to him. 

About his 2Qth year he was greatly improved in 
his general health, his mind was at times cheerful, 
and even happy, more so than it had been from the 
age of J 4 or i5. In short, in respect to his feel- 
ings, he was quite a new man. 

One morning about this period while in bed, he 
experienced the most unconquerable desire for sex- 
ual connection, but not having it in his power to 
gratify his desires at the time, he had recourse, the 
first time for five or six years, to his old habit. He 
was immediately after seized with a degree of stu- 
pidity, and a kind of derangement, different and 
much more distressing than he had ever before felt ; 
a profuse sweat, too, instantly covered his whole 
body, so as to render his linens quite wet. He de- 
clared he never was in such a state of complete 
misery, and he earnestly wished that every moment 
might terminate his existence. He suffered a sort 
of delirium, yet was sensible of his state : He leaped 
out of bed and bathed his face in cold water, but 
this only seemed to increase his sufferings ; fee put 
on his clothes and stalked about the house like a 
person in despair ; he drank several glasses of wine, 
then ardent spirits, but they had no effect on him. 
After this he went back to bed, to endeavour to 
procure some sleep, and the spirits he had used 
assisting him, he slept about two hours He was 
now somewhat refreshed, but still his mind was very 
much and strongly confused ; he felt as if afraid of 
entirely losing his reasoning faculties ; indeed he 
assured me that language could not convey his 
feelings at that time, and tor nearly two years after, 
when he applied to me. 



171 

It is strange, that this patient scarcely had au 
emission oftener than once in eight, ten, and some- 
times fourteen days; yet it is evident, that the ef- 
fects produced on his general health, arose from 
the generative organs, caused by the same means 
which had, in all my patients, occasioned seminal 
emissions. 

Previous to his application me, he used bark and 
wine, and carbonate of iron, which considerably im- 
proved his digestive organs, and even his general 
health ; but still he was stupid, and, as he expressed 
himself, strange even to himself. 

As there seemed to be no symptom or affection 
of any organ to contraindicate the administration 
of the cantharides, I did not hesitate to prescribe 
that medicine to this patient, according to the me- 
thod formerly adverted to. I at the same time 
recommended the use of the cold bath. 

He took the medicine eight months and two 
weeks, before he experienced any thing more than 
temporary relief from it. He had frequently, for 
a day or two, experienced greater comfort than be- 
fore its administration, but he uniformly relapsed 
into his old state. At the end, however, of the 
above period, he felt sensibly invigorated ; his mind 
was more chearful, his testicles were not nearly so 
relaxed as formerly; and his penis, which had shrunk 
considerably under his abdomen, was greatly elon- 
gated. He, however, continued the use of the 
medicine about seven months more, and he is 
now perfectly recovered. His mind is still occa- 
sionally gloomy, but that is of short duration ; and 
upon the whole, he enjoys his life with consider- 
able comfort. 



I have only met with one case of seminal emis- 
sion, where, from the deranged state of the parts,, 



172 

occasioned by the disease, they could not be restor- 
ed to their healthy action. The emissions entirely 
disappeared, at least did not return oftener than 
once in two months, and every symptom, such as 
the painful erections in the night, horor of mind, 
and general debility, also disappeared ; but still 
there existed a disagreeable sensation in the parts 
of generation, for which no more than temporary 
alleviation could be obtained. The patient con- 
tinued the use of the cantharides about eighteen 
months, and in every respect, except the above 
sensation, has now completely recovered his health. 
He has taken no cantharides for these five months, 
and still he continues stout and active, and in bet- 
ter general health than he has enjoyed for many 

years. 

- i— 

Of Diseased Prostate. 

There are few, perhaps no well authenticated 
cases, of a cure having been affected in diseases of 
the prostate gland, where the cause is not venereal. 
Topical applications are here. of no use. Almost 
the only relief, I believe, which we can expect, is by 
the occasional introduction of a bougie or catheter, 
to draw off the ur ine when it becomes trouble- 
some. 



Of Gleet. 

I shall now proceed to point out and illustrate, 
a variety of peculiarities and circumstances respect- 
ing the cure of gleet, of which the safety of the pa- 
tient requires that his medical attendant should be 
well aware. 

Gleets have sometimes disappeared spontaneous- 
ly ; though, when neglected at first, they have more 
frequently baffled all the means that were employed 
to remove them. 



273 

Sometimes they have been unexpectedly remov- 
ed by such means as induce an inflammatory action 
of the parts ; as irritating substances thrown into 
urethra, a bruise, a fresh gonorrhoea, the superven- 
tion of chancre. 

," * I knew a gentleman," says Mr Hunter, " who 
threw into the urethra, for a gleet of two years 
standing, Goulard's extract of lead, undiluted, which 
produced a most violent inflammation ; but when 
this inflammation went off, the gleet was cured." ' 

My brother communicated to me the following 
instance of gleet cured by a bruise. 

" I knew a dragoon officer in Villiers' regiment, 
who was cured of a gleet of eighteen months dura- 
tion, by an injury done to the penis. He was 
thrown out of his seat when hunting, and his penis 
was so severely squeezed between the pummel of 
his saddle and his pubes, that a violent hemorrhagy 
ensued ; this was succeeded by a very considerable 
degree of inflammation, pain, and the secretion of 
puriform matter ; and when the inflammation sub- 
sided, he found that he had got rid of the gleet. 

That gleet is often removed by a fresh gonor- 
rhoea, is familiar to every one. 

" I have seen a chancre," says Mr Hunter," page 
220, "coming upon the glans, absolutely cure both 
a gleet, and an irritation all along the passage of 
the urethra. So great was the irritation in this case, 
that I suspected a stricture, but, on passing a bou- 
gie, found none. I have seen this sympathy extend 
over the whole pubes, and so strong, that touching 
the hairs gently on the pubes, has given disagreea- 
ble sensations, and even pain." 

Facts of the same kind have came under my own 
observation. 

* See page 104 of his book on Venereal Complaints. 



174 

* Fordyce thinks, that gleets are continued by 
the remaining venereal virus, and, accordingly, are 
to be removed by its antidote, mercury, 

" If the bougie passes freely, you will do well to 
set about the cure, by a proper quantity of mercury 
rubbed on. 

" This quantity can, I think, be ascertained only 
by the change brought upon the matter in respect 
to its colour, or consistence : where such change 
does not take place, as will sometimes happen, I rub 
on three or four ounces, so as scarcely to leave the 
possibility of a pockv cause remaining." 

What he says here concerning the changes of 
the matter, shews that it was not the pocky cause, 
but the atony of the parts, that he removed, by in- 
ducing inflammatory action, or rather the suppura- 
tive stage. " How many obstinate gleets," says he, 
" of two, three, or four years standing, have we 
seen effectually cured by a mercurial inuncection V- 

This is one the many instances which show, how 
powerfully hypothesis influences our minds, and 
vitiates our reason. He never dreamed, that these 
complaints might have been much more easily cur- 
ed, by the other means that induce inflammation, 
quite independently of any such remedies as may 
remove a pocky cause. 

The cases, called by Mr Whately gonorrhoea^ 
which he cured by the stimulant injections of the 
muriate and submuriate of mercury, were those of 
such gonorrhoeas as are synonymous with gleets ; 
and I would venture to make a similar remark on 
the cases of gonorrhoea and leucorrhoea, which 
Pearson and Blair treated with such acids as the 
nitrous. They were at one time successful, at 
another unsuccessful, because they did not care- 

* Fordyce's Review of the Venereal Disease, 2d edition, p. 
51, of Gleets, § 8. 



175 

fully discern the difference in the diathesis, when 
these remedies were exhibited. 

Mr Hunter is of opinion, that the consequence 
of gonorrhoea is often incurable, (page 34.) " These 
diseases may be considered only as an inconve- 
nience entailed on those who have had venereal 
gonorrhoea No certain cure for them is known; 
tliey are similar tn thejiuor albus in women. 

But I affirm, with no small degree of satisfaction, 
and the cases to be related will prove what I af- 
firm, that such gleets and fluores albi as Mr Hun- 
here pronounces incurable, are just the same as 
those which have completely disappeared during 
the internal administration of cantharides. 

Mr Hunter, mentions these diseases in terms 
much too mild ; for every practitioner must have 
known, from his own observation, that they are 
not only inveterate, but have the most distressing 
consequences. Falck. was well aware of this. 
" There is," says he, (p. 132), " something so very 
gentle in the sound of a gleet, that the patient is 
very little concerned at it ; and too frequently less 
so, the practitioner he applies to : for my own part, 
I had rather cure ten recent virulent claps, than 
one old standing gleet." 

Although, for a considerable length of time, gleet 
is only a local disease, yet the application of local 
means seldom, except in the most trifling cases, ef- 
fect a cure. But stimulating remedies, being ap- 
plied to the general system, the parts affected, as a 
part of the whole, are restored to their healthy ac- 
tion. 

I would not be misunderstood, when T speak of 
curing gleet by a stimulating plan ; for, irregularity 
in diet, indulgence in strong liquors, excess of ex- 
ercise, all do harm in every case of gleet. These 
complaints, Ihavefoundtobemost successfully treat- 
ed by moderately nourishing diet, and gentle exer- 
cise, the internal use of the balsams, bark or the 



176 

carbonate of iron, sea bathing, with injections of the 
infusion of cinchona, or of the quercus robur and 
kino. Sometimes, however, these means only serve 
to alleviate the complaint ; and the discharge con- 
tinues of a puriform appearance and consistence. 
When this occurs, it should be treated as a confirm- 
ed gleet. 

I have, in a former part of this work, pointed out 
these varieties, or rather various states of gleet, 
which I recollect to have occurred in practice ; 
"and, I believe, there is no instance where the treat- 
ment should be exclusively local, or exclusively con- 
stitutional ; for in all cases we must attend to the 
stomach and bowels, and to the state of the discharge 
from the urethra. In some cases, our treatment must 
be chiefly constitutional, and in others chiefly local. 

In cases of confirmed gleet, accompanied with 
general debility, our treatment must be chiefly con- 
stitutional ; for here no stimulant injections into the 
urethra can in the least promote a cure ; nay, I af- 
firm, without hesitation, because I have really seen 
it happen in analogous cases, that local applications, 
used even so strong as to destroy the parts altoge- 
gether, would never induce healthy inflammation ; 
but when the system is assisted by internal reme- 
dies, this healing action can be induced and main- 
tained with safety, without the necessity of any 
acrid local applications. 

In cases of mild or incipient gleet, where the 
health is sound, we may, at first at least, trust to lo- 
cal means. 

There is one local aoplication, which, although 
in many thousand instances injudiciously applied, 
has been of the greatest utility, and which should 
certainly not be overlooked,— I mean the bougie. 

There are plethoric habits, although not very 
commonly met with, enjoying to all appearance 
health and vigour, which yet cannot well bear either 
the antiphlogistic or phlogistic regimen. 



177 

In these habits the constitution may be otherwise 
sound, yet there may be great atony of the penis, 
and an obstinate gleety discharge, so that the com- 
plaint is, as far as can be in a system constituted 
like ours, completely local, and yet does not yield 
to the cold bath, cold ablution, stimulant nor seda- 
tive injections ; but a tolerable thick bougie, prepar- 
ed after the manner of Le Dran, besmeared with 
olive oil, containing tinct. opii, will distend the ure- 
thra, promote the circulation there, and throughout 
the vicinity, induce inflammatory action, and the 
formation of laudable pus ; and, in fine, complete 
the cure. 

So that we have a most excellent resource, when 
constitutional means are not indicated, or would 
be detrimental, and when the more common local 
and external means are ineffectual. 

There are others, who, though they can scarcely 
be deemed of very sound or healthy constitutions, 
yet enjoy their usual health. Such are people pre- 
disposed to apoplexy, to phthisis pulmonalis, asth- 
ma, &c. when they take such medicines as excite 
the system, they are seized with headache, vertigo, 
breathlessness, or similar symptoms. 

In such cases, when injections have failed, we 
shall often succeed by the bougie. To some persons, 
however, the bougie is intolerable. 

But though, in particular cases, internal stimu- 
lants are dangerous, injections ineffectual, bougies 
inadmissible, we are not without resource ; for vesi- 
catories, applied to the perineum, will, in many in- 
stances, remove the. disease. 

Thus we see how necessary it is to attend to pe- 
culiarities of constitution, and to vary our means of 
cure accordingly. 

No man's genius was ever more fertile in expedi- 
ents, in difficult cases, than that of Mr J. Hunter ; 
and as his experience with regard to vesicatories, in 
M 



173 

circumstances somewhat similar to those in which 
I would advise their use, completely corresponds, 
with my opinion of their utility, I hope I shall not 
be blamed for quoting the following very instructive 
facts and observations : 

* " A blister applied to the perineum will entire- 
ly cure some of the remaining symptoms, even 
when they extend towards the bladder, as will be 
explained hereafter ; indeed, it appears to have 
more effect than any other remedy. A blister to 
the small of the back will also give relief, but not 
so effectually as when applied to the perineum 

" This practice," continues Mr Hunter, " is not 
only of service where there has been a preceding 
gonorrhoea, but I have found it remove, almost im- 
mediately, common stranguries, where the turpen- 
tines and opium, both by the mouth and anus, had 
proved ineffectual, and when the catheter had been 
necessarily introduced twice a day, to draw off the 
water. 

!** Electricity has been found to be of service in 
some cases, and therefore may be tried either 
in the first instance, or when other means have 
failed." 

And he further adds : (p. lo6.) " A gentleman in- 
formed me, that he had cured two persons of gleets, 
by applying a blister to the underside of the ure- 
thra ; and I have known several gleets of old stand- 
ing, after having baffled all common attempts, cured 
by electricity." 

f Mr Ben. Bell, found vesicatories of thecantha- 
rides, the most effectual remedies he ever employ- 
ed, when the glans of the urethra were affected. 

In the opinion of surgeons, with regard to gleets, 
there is an error which cannot be too speedily ex- 
ploded. A celebrated surgeon, for instance, as- 
sured me, that it was his firm belief, that ninety- 

* Hunter, p. 93. f Bell, on Gleets, p. 204. 



po: 



179 

nine gleets in the hundred depended on stricture, 
and were to be cured by the caustic bougie. 

How then does it happen, that in my prac tire, 
and I believe I have seen as many gleets as most 
medical men, I do not find one in the hundred in 
whom there is any stricture ? Nay, in by far the 
majority of cases, there is not the shghest impedi- 
ment nor diminution in the flow of urine. 

This appears to be the principal source of the 
mistake ; they think, that since bougies act by dis- 
tension, or by cauterizing the parts, and thus re- 
move gleets, these gleets must depend on contrac- 
tion ; but the fact is, that the bougie acts as an 
external stimulus, exciting the membranous and 
muscular structure of the urethra, and produces in- 
flammation, as we have stated above, and thus the 
cure is accomplished. 

The following occurrence has also contributed 
not a little to this error ; often when a bougie is in- 
troduced, it excites the urethra partially or general- 
ly into contraction, and this temporary obstruction 
is rashly pronounced a stricture ; caustic has been 
applied to remove it, by which, and the repeated 
irritation of the bougie, real strictures have been 
formed, with consequences the most distressing to 
the patient. 

Repeatedly, in the early part of my practice, this 
has puzzled me ; for the bougie would stop fre- 
quently at the very same spot, and receive a mark 
from the interruption ; but, by soaking the parts in, y 
wannjvajtexuand injecting oil, or oil with opium, in- 
to the urethra, I have generally, after a few at- 
tempts, succeeded in getting the bougie into the 
bladder, not, however, without difficulty, for new 
interruptions, of a similar nature, oppose our pro- 
gress : but one yeilds after another, till at last we 
accomplish our purpose ; and, atter withdrawing 
the instrument, the same obstacles will perhaps op- 
pose its reintroduction. 

M 2 



J 80 

There is, at least, one other $ause of fallacy ; 
part of the urethra often remains so irritable, that 
it is provoked into contraction when any acrid sub- 
stance is applied ; hence it often happens, that 
when the urine enters the urethra, it produces very 
painful sensations ; the urethra contracts, and the 
urine either flows in a very small stream, or it is 
quite interrupted. 

Here, as in the former instance, the bougie, on 
entering, excites obstructions to its own passage in- 
to the bladder, but they are removeable in the same 
way ; and having once ascertained the absence of 
stricture, the reintroduction is unnecessary. 

There are numberless instances in which the 
stricture has been removed, and yet the gleet has 
remained, not to be cured by the bougie ; in Mr 
Home's works we shall find many examples of this 
fact. 

Finally, all the means which have been known to 
cure gleets, may be comprised under one head ; 
such as promote and invigorate the functions of 
the parts affected, or the system in general. 

CASE. 

A Gentleman, aged 21, applied to me on ac- 
count of a gleet of great inveteracy, and very long 
duration ; he said, that the affection only annoyed 
him by its being uncleanly ; and the remedies he 
had employed, being both ineffectual and more 
troublesome to him than the disease itself, he con- 
tented himself with washing the parts frequently, 
in expectation that it might wear off through time. 

I represented to him, that the consequences 
might be dangerous, and that he should not look 
on it with such indifference ; adding, that I believed 
means might be found to remove his complaint. 
Accordingly, I prescribed for him the tincture of 
cantharides, and after his complaints underwent va- 



181 

rious changes, he entirely recovered in rather more 
than two months. 

CASE. 

A Gentleman, aged 30, stout, and of dark com- 
plexion, when intoxicated, had caught a gonor- 
rhoea. 

I examined the parts, and prescribed for him. 
Of this disease he was completely cured before the 
expiration of a month. 

A few months after, he again begged I would as- 
sist him, as he had for two weeks past been se- 
verely troubled with a thin transparent emission 
from the urethra, attended with a sense of weak- 
ness, that much impeded his attention to his busi- 
ness, and he was afraid might speedily undermine 
his constitution, which was otherwise good. I pre- 
scribed the tincture of qantharides, which he con- 
tinued to take for about two days, when great pain 
and inflammation of the urinary passages attacked 
him ; wherefore, I prescribed a mild solution of 
sulphate of zinc, to be used as an injection into the 
urethra, and, at the same time, 1 ordered him a 
smart cathartic. 

After this, the inflammatory symptoms rapidly 
abated, the discharge which had assumed the puri- 
riform appearance of that of gonorrhoea, became 
daily less in quantity, and in about a week it was 
entirely cured. 



In this instance, inflammatory action was excited 
by a very inconsiderable quantity of the tincture of 
cantharides ; and, indeed, I have invariably, so tap 
as I can recollect, found, that the shorter the du- 
ration of the gleet, and the more healthy and stout 
the patient, the sooner were the inflammatory 
M3 



182 

symptoms in general induced ; shewing, as I pre- 
sume, that the effects of the remedy depend much 
on the state of the general constitution ; and not 
simply on any peculiar local influence on the organs 
ot urine. Other cases, however, which I shall pro- 
duce, in my opinion establish the truth of the re- 
mark beyond the reach of doubt. 

CASE. 

A. Gentleman, aged 55, a small meagre man, 
married, and father of a family. He mentioned to 
me, that he laboured under an uncommonly severe 
gleet, but at the same time said, that he had no 
hopes of cure, as many practitioners, both in Eng- 
land and Scotland, had prescribed for him in vain ; 
but, as the effects of it were now very severe, he 
requested 1 would devise some method of relief, as, 
to use his own phrase, life was become a burden to 
him 

On minute inquiry, I found that he had been af- 
fected with a discharge of this nature from the ure- 
thra for about '10 years, which he attributed to the 
effects of a bad custom, originally commenced at 
school, and since aggravated by repeated claps. 

Such was his situation, that besides a continual 
gleety discharge from the urethra, emission of se- 
men succeeded the most trifling erection, and 
straining at stool had the effect of producing it; 
which was followed by langour, and great depres- 
sion of spirits. 

Though married, connubial enjoyment was be- 
yond his faculties ; but this was not his only mis- 
fortune ; hcadach, loss of appetite, lumbago, incon- 
tinence of urine ; in fine, general emaciation and 
d*.biiu\, threatened the speedy termination of his 
lite. 

AH the most common means had been employed 
to remove his complaint ; accordingly, to make him 



183 

Undergo a repetition of the same, was neither con- 
sonant to my feelings, nor to the state of my patient. 
I therefore prescribed for him the tincture of can- 
tharides, which he continued to use, progressively 
increasing the doses, for about a month, when his 
complaints disappeared. 

He left this city soon afterwards, and repaired to 
London, where his family were ; but his kind wife, 
expecting nothing more than she had for many 
years received, made no demands, and he, for his 
part, did not endeavour to convince her of her mis- 
take, but exerted his powers in a way not quite so 
legitimate as moral probity could wish, of which 
there in a short time appeared living evidences. 

This patient, however, had a return of his semi- 
nal emissions, but by a perseverance in similar treat- 
ment for a few months, he entirely recovered. 

CASE. 

A Gentleman, aged 23, had laboured under 
a gleet for some years ; he applied first to a sur- 
geon in town, who gave him the common injec- 
tions. They arrested the running for a short time, 
and when it returned, he applied to another surgeon, 
who advised the balsam of copaiva ; and, after he 
had used it for about a month, bougies were em- 
ployed. Their introduction gave him little unea- 
siness, and their use did no service ; he recom- 
menced the balsam, but in vain. Sometimes, in- 
deed, these remedies seemed advantageous ; but the 
disease was now worse than ever. 

I told this gentleman, that I had more than once 
experienced the most complete salutary effects irom a 
certain method of treating gleets, which I had adopt- 
ed within these few years ; but that 1 could scarcely 
advise him to attempt it, on account of his extreme 
irregularity of living, as it would require uncommon 
attention, both on his part and on mine ; otherwise 
M 4 



184 

the consequences might be very troublesome, if not 
dangerous He replied, I had nothing to fear, since 
his passion for the fair had lost its predominance. 
His general health was much impaired, and a very 
small proportion of wine or ardent spirits, intoxi- 
cated him. He said, too, that it was out of hi? 
power to remain in town, but that I might pre- 
scribe without fear, as he was resolved to obey my 
injunctions most minutely. Accordingly, I gave 
him a portion of the tincture of cantharides, and he 
was instructed to pay the utmost attention to any 
change that might occur in the state of the dis- 
charge ; whether pain supervened in the penis, 
kidneys, or stomach, or any difficulty in making 
water; and if such symptoms occurred, to intermit 
or diminish the doses of the medicine, according 
to their severity ; but if they did not at all inter- 
vene during its use, to let me know in time, that I 
might transmit him a supply, before the first quan- 
tity was finished. 

Consequently I received a letter from him stating, 
that no pain had troubled him, and requesting to 
know how he should next proceed. 

I ordered him a second mixture like the first, but 
to be taken in increased doses : he had only taken of 
it a few times, when he was seized with excruciat- 
ing pains in the parts of generation, with an almost 
complete strangury : he now ceased to use the 
cantharides, till he should receive farther instruc- 
tions. I wrote him instantly to bathe the parts 
with warm water, to take a cathartic, and use the 
injection into the urethra, with both of which he 
was furnished on his departure from town ; request- 
ing hirn> at the same time, to let me know, by re- 
turn of post, how he should feel, alter he had ob- 
served the directions then givep ; but I got no o- 
ther information concerning this case till several 
months afterwards, when I saw him in town ; he 
was then married ; and I had the pleasure to receive 



185 

thanks for having accomplished in him a perfect 
cure. 

CASE. 

A Gentleman, aged 32, stout and active, 
contracted a gonorrhoea, which, in consequence of 
inattention, was not removed for more than two 
months. 

Six months after he perceived a slight gonorrhceal 
discharge, but was willing to allow that he had ex- 
posed himself to a fresh infection. 

He now used injections, nitras, and supertartris 
potassae, and the cold bath daily, with apparent ad- 
vantage ; but the least irregularity in diet or exer- 
cise renewed the discharge. 

He at length became tired of medicines, and 
confined himself to the cold bath once a-day ; all 
pain was gone ; but the discharge and debility of 
these organs proceeded increasing. Wherefore, by 
my advice, he commenced the use of the tincture 
of cantharides, but, as he scarcely expected any ad- 
vantage from the medicine, did not use it with any 
punctuality ; he however increased the doses, re- 
covered completely, and is now married, and re- 
mains well. 

CASE. 

A Gentleman, aged 25, was affected with gon- 
orrhoea, to remove which he employed the common 
means with success. 

1 he discharge had never been very copious, 
was of a glairy appearance, and he suffered much 
from a continual soreness in the urethra, about an 
inch from its external orifice, but did not think, 
that the stream of his urine was smaller than for- 
merly. 



166 

He had lately been living rather irregularly, and 
now complained of incontinence of urine. 

I wished to introduce a simple bougie, to ascer- 
tain the state of the urethra ; but he would not 
allow it to be done. 

I then prescribed the tincture of cantharides for 
a few weeks, when the discharge diminished gradu- 
ally, and at last disappeared, leaving, however, a 
certain sensation, scarcely to be called uneasy, in 
the urethra, particularly on making water. He 
went into the country, had much exercise on horse- 
back for some days, got himself frequently wet, 
and also exposed himself to a new infection ; soon 
after which, the discharge returned, and the sensa- 
tion went off. This new discharge was whitish, 
watery, and very copious. 

Are we to consider this a new infection, or as 
the effects of the former disease not completely 
cured ? 

We are to observe, that there still remained a 
certain sensation in the urethra, which went off 
when the discharge returned; and that the new 
attack was neither ushered in, nor accompanied 
with inflammatory symptoms ; and when we re- 
collecty that gleet often succeeds gonorrhoea at 
some distance of time, it is not improbable, that 
the peculiar sensation above described, was a relic 
of the inflammation which the cantharides had ex- 
cited, which terminated in the atony of the parts, 
and a removal of the gleety discharge. 

There are some particular circumstances, which, 
in some measure, invalidate this opinion. The 
dischage at first was not of a very inflammatory 
kind, nor very copious, but became very copious 
during the complaint ; but there was a continued 
pain and soreness in the urethra after the first 
attack, which has, on the second, entirely gone 
off: but, had it been a fresh infection, have we 



187 

not reason to think, that the pain would have been 
renewed ? 

On the whole, then, I am inclined to think, that 
this was a relapse of the former complaint 

I again wished to introduce a bougie, to ascer- 
tain the state of the urethra ; but he would not 
suffer it. On the idea that this was a relapse of 
the affection, I advised him to resume the use of 
the tincture of cantharides; but he refused this 
also, saying he was tried of it. I then gave him 
an injection of sulph. zinci, expecting, that the in- 
veteracy of the discharge would at last induce him 
to re- employ that remedy, which had already been 
of service to him. He used the injection occa- 
sionally, but the discharge continued unabated. 

In the beginning of August following, he inform- 
ed me, that having indulged himself lately with a 
female friend, a great quantity of blood flowed from 
his urethra during the night, and next morning 
he found that the gleety discharge had nearly dis- 
appeared, and with it the disagreeable feeling which 
had again attacked the urethra. 

I ordered him to continue the use of the injec- 
tion. 

He told me, about twelve weeks afterwards, that 
his complaint had entirely ceased, and that he had 
long given up the use of the injection. 

This event seems to confirm the opinion which 
I had formed of this occurrence ; for, is it not pro- 
bable that the discharge proceeded from the above 
mentioned painful spot, which was healed by the 
inflammation that followed the hemorrhagy ? 

CASE. 

A Gentleman, aged 29, stout made, had a go- 
norrhoea about three years before he consulted me, 
which was cured by the usual means. 



188 

When he applied to me, he was affected with 
symptoms of a violent nephralgia caleulosa, of which 
he conceived himself perfectly cured by the pill 
sodas,* in about six weeks, during which he void- 
ed in his urine a great deal of something resemb- 
ling sand. 

Soon after this, a gleety discharge made its ap- 
pearance, and continued long to affect him. 

From the previous affection, and the continual 
uneasiness in the region of the kidneys, particular- 
ly when the discharge is aggravated by hard ex- 
ercise, or hard drinking, we have reason to pre- 
sume, that a disorder of the kidneys had no small 
share in this complaint. 

After drinking, he had always observed, that the 
matter discharged becomes much thicker ; but this 
inspissation soon degenerates, and the discharge re- 
sumes its gleety appearance. 

I prescribed for him the tincture of cantharides, 
which, before the cure, caused a very great increase 
iu the discharge. This, however, gradually disap- 
peared, and he is now perfectly well. 

CASE 

A Gentleman, aged 35, a robust man ; lived 
Very irregularly for several years, without much ap- 
parent injury to his constitution. 

He contracted a gonorrhoea, for which he used 
injections of various kinds ; but in the course of a 
few months, it declined into a gleet, which did not 
trouble or alarm him much, till one evening, about 
two months afterward, after drinking a very great 
quantity of port, he suffered a complete suppression 
of urine for several hours, after which, the water 

* These pills are composed of equal parts of calcined soda 
;ind bread. In many instances, I have found them of great ser- 
vice in these complaints. 



189 

came away in drops, attended with great pain. A 
medical man, to whom he related the above ac- 
count of his disease, proposed to introduce a bougie ; 
but to this the patient would not submit. Almost 
immediately after taking a dose of the phosph. 
sodas, he passed his water freely ; the gleety dis- 
charge remained as formerly, but somewhat thicker 
in consistence. He used no other remedy. 

About a week before he consulted me, a pain at- 
tacked him in the perineum, where I found an ele- 
vated spot, painful when touched. He passed wa- 
ter without pain, and frequently in a full stream ; 
but it sometimes stopped suddenly, and then the spot 
above mentioned became painful, and continued 
so for nearly half an hour. I prescribed for him 
the tincture of cantharides, which he continued to 
use with considerable steadiness for nearly a month, 
when he was perfectly recovered. 

This case was mistaken for one of stricture ; and 
since most surgeons believe that the gleety dis- 
charge is for the most part only a symptom of 
stricture, the mistake was very excuseable, par- 
ticularly here, where some of the characteristic 
symptoms of stricture, with complete suppression 
of urine, were present. 

This case shews the necessity of distinguishing 
between spasmodic and permanent strictures ; for, 
the circumstances alone of the stoppage coming on 
suddenly with pain, and being suddenly removed 
by the means which the gentleman himself had 
used, convinced me, that this was not a case of 
permanent stricture, but an occasional partial con- 
traction of the very irritable urethra, caused per- 
haps principally by the acrimony of the urine, 
and to be removed by whatever remedies could 
restore the tone of the urethra, without distension 
by bougies, or the destruction of any obstacle by 
caustic. 



190 



CASE. 

A Gentleman, aged 1 ] , of a very irritable ha- 
bit, contracted a gonorrhoea. He used injections 
of sulph. zinci far too strong, and thus soon ex- 
cited violent inflammation of the urethra with 
strangury. In two days, the discharge of the go- 
norrhoea was almost completely removed. Oph- 
thalmia affected him at the same time. 

A surgeon of this city prescribed for him, a solu- 
tion of sulph. zinci for his eyes, applied leeches to 
his temples, and gave him smart cathartics. The 
gonorrhoea returned in a slight degree, and encreas- 
ed as the strangury abated. His surgeon told him 
not to use injections, for they almost always brought 
on strictures, but to allow the complaint to run 
itself off, which he assured him it would do in a 
very short time. All medicines, in gonorrhoea, he 
pronounced not only to be useless, but often pro- 
ductive of great distress. The pain in voiding 
urine soon left him ; the discharge became thin, 
and in great quantity, He now used injections 
composed of tinct. opii. camphor, and water ; they 
gave relief, but when their use was intermitted for 
a few days, the discharge returned of a puriform 
consistence, attended with very slight pain in void- 
ing urine. 

I desired him to discontinue the injections, and 
I prescribed for him the tincture of cantharides, 
which he continued to use with varied success for 
upwards of two months, when his complaint had 
entirely left him. 

During his use of the cantharides, the glands in 
the axilla inflamed, suppurated, and broke, but they 
healed very speedily. 



191 



TREATMENT 



SPASMODIC STRICTURE. 



Introductory Remarks respecting the cure of Stricture 
in General. 

With regard to stricture, I once proposed mak- 
ing a general review of the best of the numerous 
books which have, especially of late years, been 
written on that subject. I now, however, find that 
the opinions of every author, respecting the points 
which seem to me to demand greatest attention, 
(viz. the practical ones,) are so nearly alike, that 
a plan of this extensive kind would not only be un- 
interesting, but unnecessary. 

Instead of ascertaining the real nature of the 
disease, and of the plans which ought at an 
early period to be adopted for the purpose of 
preventing the urethra from assuming that state 
of action, which might possibly require the appli- 
cation of caustic for its recovery, they seem rather 
to have taken it for granted, that such a state ex- 
isted from the first, and their whole attention has 
been directed to the invention of some sort of 
instrument, or of some new substance, for its re- 
moval. 

As, then, the publication of Mr Home's works 
in particular, on that subject has given rise to much 
controversy, and, (as a man of honour, and one 
solely anxious for the progress of medicine, I de^ 
clare it) in my own opinion, to be the cause of much 



1Q2 

unnecessary torture to many individuals, T shall, in 
the course of this publication, occasionally take on 
tice of those parts in which to me, such practice seems 
to have been unskilfully applied. As these opinions 
no doubt are the very best which Mr Home could 
adduce, and told in his very best way, as illustrating 
his peculiar notions respecting these diseases, his 
doctrine will be seen to no disadvantage, nor can 
any criticism upon them be considered as misap- 
plied. In Mr Home's practice, many cases of a less 
decisive nature must have occurred ; and, as I can 
have no opportunity of examining these, I must 
leave to the thinking part of the community, to 
conjecture the probable number of unsuccessful 
ones which must be unpublished, from those which 
I shall point out now in the hands of every one. 
This, however ungracious the task, T am constrain- 
ed to do, in order that the world may judge of the 
truth of the principle upon which they have been 
treated. Of personal motives, I have none. My 
practice and that of Mr Home can never interfere. 
I am only desirous of rectifying an important part 
of medical reasoning and practice. 

It is only necessary for any one to take a wrong 
view of the subject of which he treats, which I 
think Mr Home has most decidedly done, to ren- 
der all his speculations and proceedings, however 
ingenious, respecting it, less or more erroneous. 
Such I do not hesitate to sa}, has been too often 
the case in the reasoning upon, and treating dis- 
eases in general ; and I am sure in none so much 
as in those termed strictures in the urethra, rec- 
tum, esophagus, &c. 

Many years ago, while reading Mr Home's book 
on the subject of strictures, while I was pleased 
with the simplicity of his language and the plain- 
ness of his descriptions, I could not help thinking, 
that in the treatment of many of those cases with 
which he has favoured the world, in illustration of 



193 

his doctrines, he had applied that harsh, and I 
must say repulsive, mode of practice, where, even 
from the circumstances which he himself has stated, 
he had no right to adopt such practice ; nay, fur- 
ther, were I disposed to doubt Mr Home's authority, 
I should be inclined to pronounce that, under cer- 
tain circumstances connected with some of his 
cases, no such result could be obtained from the ap- 
plication of caustic bougies. In short, I conceive, and 
I shall attempt to prove it a very exceptionable book. 
These opinions respecting the application of 
caustic to the urethra, remained with me for some 
time scarcely more than conjecture, as I then had 
no opportunity of ascertaining the certainty of them 
from practice. Since that time, however, I have 
not only had ample opportunity of confirming 
them by experience, unbiased by any particular hy- 
potht sis or theory, but facts have crowded upon 
me from every quarter to convince me, that per- 
manent stricture in the urethra is, unless caused by 
improper treatment, a very uncommon disease, and 
that Mr Home's treatises upon that subject are even 
more faulty than at first reading we conceive therri 
them to be. Yet, strange to tell, a man, at least in 
the fashionable world, can scarcely be recognised 
as properly initiated, unless he has submitted to burn- 
ing by caustic. 

Indeed it must appear to every one, that when 
one particular mode of treatment is uniformly a- 
dopted for the removal of disease, and pertinacious- 
ly persisted in, in spite both of observation and of 
reason, we may rest assured, that the department 
of science which ought to regulate that particular 
part of our art, is either in a wretchedly imperfect 
state, or kept under and neglected from improper 
motives. Men entertaining particular practices, 
which they are never at a loss to apply, unless for 
want of a subject to apply them on, have never 
permanently ranked very high in the scientific world. 

N 



1Q4 

We have at one time been amused with animal 
magnetism in the removal of a variety of diseases ; at 
another, with electricity ; since that, with Perkin's 
tractors ; and, especially of late years, we have been 
amused in a very serious way with burning for the re- 
moval of imaginary permanent stricture. All these 
have, in their turn, been supported and maintained 
with a fury, with a madness I should say, which no 
truth in a really scientific improvement would re- 
quire for its establishment. They were at length 
found out, and, with a very few exceptions in the 
application of electricity, and more numerous in- 
stances in the last of these, viz., burning with caus- 
tic, have or ought justly to be consigned to the 
vault of all the Capulets. Indeed, on recollection 
of the novellist introducing Dr Sangrado with all 
his bombastic reasoning and his practice, which, 
as is usual even in real characters of the same kind, 
did not at all correspond with it, and after the la- 
dicrous figure my uncle Toby and Corporal Trim 
cut at their hobby, it is astonishing that science 
should be assailed, even in our own days, with follies 
equally absurd with the latter, and cruelties not less 
conspicuous than the former. 

With regard to my examination of published 
opinions, I may remark, that it has always seemed to 
me, that when a man, be what he would, submitted 
his opinions to the world, he appealed to the judge- 
ment of the world, and that these opinions should 
or ought to be examined, and only held valid, where 
unbiassed reasoning could support them I can 
have no wish, I may again observe, to object to 
Mr Home's or to any other person's doctrines as a 
private individual ; indeed in that capacity I should 
never have thought of making a single proposition 
respecting them ; I do not personally know Mr 
Home, nor have ever seen him ; but as a servant 
to the public, as one engaged in the arduous task 
of relieving human misery, in the easiest way for the 



105 

sufferer, I deerh myself perfectly at liberty, even 
without attempting to offer an apology, to make 
such remarks on his, or any other person's publish- 
ed opinions and practice, as I may think proper. 
I invite the public to do the same with my own J 
Provided they are reasonable, and deserving of no- 
tice, I shall listen to their remarks ; and if it be proved, 
and it is possible it maybe, that the opinions I have 
submitted to the public on various occasions, as 
well as those I may yet submit, are faculty or im- 
perfect, I shall not be offended, but on the contra- 
ry, pleased, either to admit, in the same public man- 
ner, of such observations, or to correct the accuser 
with all imaginable dispatch. I hope I shall always 
be equally ready to acknowledge my own faults, as I 
am to endeavour to point out those of others No- 
thing shall ever induce me to depart from this de- 
termination. 

Stricture in the urethra, then, seems to me a disease 
much easier understood, as well as removed, than 
one would expect, from the immense multitude of 
pamphlets, papers and • volumes, which have been 
written upon it, as well as from the controversies, 
wranglings and disputes, which the very name of 
this disease has given origin to. In short, the ma- 
ny publications which this disease, demonstrates 
clearly, that much misunderstanding exists respec- 
ting its real nature, even among those who pre- 
tend to teach others every thing respecting it. As 
stricture then of any kind, and healthy action in 
the same parts, are incompatible with each other, 
the first object of the surgeon is, during the exist- 
ence of stricture, to ascertain, which he may do by 
unbiassed examination, in the greater proportion of 
cases, what the particular action is which preponde- 
rates in the urethra at the time. Spasmodic action 
may exist in a violent degree, independently of any 
cause which we can assign for its presence ; it may 
also exist in consequence of long continued debility 
v 2 



196 

of these parts, and to be preceded, accompanied, or 
even followed, either by gleet, seminal emissions, or 
tot J unpotency. Permanent stricture also may ex- 
ist in consequence of long continued spasmodic 
stricture, causinga depositation of matter at the spot, 
and may be occasioned by any of the preceding 
causes ; but is most generally mduced, in a greater 
or less degree, by the rude application either of com- 
mon or of caustic bougies. 



Treatment. 



It is a curious fact, which I cannot avoid intro- 
ducing, that, since my practice in diseases of the ge- 
nerative organs has been rather upon an extensive 
scale, almost every gentleman who consulted me, 
did so in consequence, as he asserted, of being af- 
fected with permanent stricture. But I found that 
that disease was scarcely ever the one with which he 
was affected ; that the various sensations he com- 
plained of, arose principally from debility of these 
parts, or from strictures purely spasmodic, and re- 
movable only by the use of stimulating, or by antis- 
pasmodic medicines internally administered, or ex- 
ternally applied. 

Mr J. Hunter observes, that 9 when a bougie can 
readily pass, there is no necessity for using any other 
method to remove the stricture ;" and I certainly 
would add to this, that when the urine can flow in 
a full stream through the canal, there is no necessi- 
ty for applying either the one or the other, although 
in Mr Home's book, we find many cases in which he 
applied caustic when the stream was sufficiently 
large. A bougie, however, being in some of these 
cases introduced, brought on spasm, for the removal 
of which he applied caustic, and, as he observes, the 
patient, in some cases completely, and in others 
nearly, recovered. 



197 

It is very evident, from the language even of the 
advocates both for the application of caustic, and 
for the use of the common bougie, in the removal 
of stricture, that the contraction of the parts is very 
apt to return, and it is also allowed, that a relapse, 
after burning with caustic, is uniformaly worse than 
after the use of the simple bougie. Thus it is evi- 
dent, on both sides of the question, that their appli- 
cations are more calculated to remove the effect of 
the contracting power, than the cause of that disease. 
Indeed, no topical application alone can effect this 
purpose. The writers on these subjects want some- 
thing, but they do not know what they want ; some 
indeed recommend internal medicines, and external 
applications, for the relaxation of strictures ; but 
these substances are recommended in so ill arranged 
or contracted a plan, that they cannot be used with 
decided advantage. 

Although, from various circumstances, we may be 
able, with tolerable certainty, to ascertain whether 
an obstruction in the urethra has arisen from per- 
manent or from spasmodic stricture, yet the chances 
of deception, from the similarity which in many 
instances exists between these diseases, ought, pre- 
vious to the use of the caustic, to induce us, in every 
case, to try every means for the removal of the 
spasm, lest that should be the sole disease. This I 
say, ought at all times to be done, notwithstanding 
Mr Home's arguments, that burning these parts is 
attended with little or no pain, and far less risk ! 

Instead of wailing for the relief of the spasm by 
internal or external applications, particularly if the 
case be urgent, Mr Hunter also recommends, in 
page I64 of his book on the venereal disease, the 
immediate application of the catheter or bougie. 
But even under these circumstances, I think the 
practice extremely harsh, as it must at all times occa- 
sion not only the most excruciating pain, and a 
greater degree of contraction, but, in perhaps every 
instance, must, in a greater or less degree, rupture 
1*3 



1Q8 

the parts, and thus rather accumulate than remove 
the source of evil. The steady use of internal me- 
dicines, and external applications, are therefore in 
the first instance indispensibly necessary ; and if the 
urgency of the symptoms will not allow us to wait 
. their effects, it were better that we should puncture 
in the perinseum or rectum, beyond the contracted 
part of the urethra, than follow the plan recom- 
mended by Mr Hunter, and entail on the patient 
irremediable mischief* 

Mr Hunter, however, by no means wanted a 
knowledge of the power of antispasmodic medicines ; 
but, with the order of their application for the re- 
moval of stricture, he does not seem to have been 
at all acquainted ; for, under the very circumstances 
where their use was absolutely necessary, he does 
not once hint at their employment. " The time," 
says he in page i2l, " that each bougie should re- 
main in the passage, must be determined by the 
feeling of the patient, for it should never give pain, 
if possible. Going beyond this point is destroying 
the intention, increasing the very symptoms that 
are meant to be relieved, and producing irritation, 
which, for a time, renders the further application of 
the bougie improper." Now, had Mr Hunter made 
the proper applications previous to, and during the 
employment of these bougies, many, perhaps all, 
of these distressing symptoms would never even 
have occurred, and the bougie consequently might 
have continued with impunity, with perhaps few, if 
any interruptions to its use, till the cure rendered its 
further application unnecessary. Neglect of these 
considerations did not exist with Mr Hunter ; for 
every one who has written on the dilatation of stric- 
ture by the simple bougie, has similarly erred. Mr 
Hunter, in the same page evidently testifies, that he 
wanted only a knowledge of these means to insure 
his complete success in the cure of such strictures. 
By his cautious management, he even succeeded in 
the removal of many without them. He here ofe 



199 

serves, that " the bougie should be increased in size 
according to the facility with which the stricture di- 
lates, and the ease with which the patient bears the 
dilatation. If the parts are very firm, and very ir- 
ritable, the increase of the size of the bougie should 
be slow, gradually stealing upon the parts, and al- 
lowing them to adapt their structure to the increas- 
ed size." Although, however, these strictures were 
dilateable without any means being applied to pre- 
pare the system for such practice, it does not follow 
that such means are unnecessary, but highly proper, 
as affording a much easier method of cure than the 
one formerly in use. 

Mr Whately justly observes, in page 63 of his 
pamphlet respecting Mr Home's practice, that " it 
is essentially necessary, in our present imperfect ac- 
quaintance with the caustic, to endeavour to dilate 
all strictures of the urethra, by means of common 
bougies, before any attempt be made with the caus- 
tic to effect their cure." This is a most important 
point, and I am sorry to say that in practice it is 
seldom, indeed scarcely ever, attended to ; but even 
when such a method has been adopted, from the 
general system, as well as the immediately affected 
parts, not being previously prepared by internal me- 
dicines and external application, it is scarcely ever 
attended with permanent benefit ; indeed, on the 
contrary, by thrusting a bougie in the urethra, with 
sufficient force to distend the contracted part, we 
oftener increase the distress than relieve it. 

I wish particularly to insist on this, that either 
pressure by a bougie, or the wedging process, which 
are the methods recommended for their dilatation, 
are, in a great majority of cases, impracticable, un- 
less proper measures have been previously adopted 
to suit the system for such practice. I allow that, 
in some cases, simple pressure will effect a cure, but 
it must always occasion more pain, and be more 
slowly, and after all, less perfectly removed, than 

N 4 



200 

when these means are assisted by general medicines. 
The most ordinary effects of a bougie alone, in 
th< se cases, must be well known to every one who, 
in the unprepared state of the system, has ever em- 
ployed that unscientific practice When passed 
through the stricture, already very irritable, as well 
as the parts beyond it, they became more so by the 
aggravation of an extraneous substance being applied 
to them. If constant and enlarged bougies are fol- 
lowed up one after the other, all the parts in the 
vicinitv of the stricture must be increased in irrita- 
bility ; for the bougie once introduced, has not open- 
ed the obstruction, but inflamed it, and consequent- 
ly the stream of urine has not improved but lessen- 
ed. After attempts have not succeeded, because the 
passage is narrowed in consequence of the inflam- 
mation induced ; that inflammation is allowed to a- 
b ite, the bougie is again introduced, it finds a sort 
of passage, but, on being withdrawn, the inflamma- 
tory effects as formerly are again produced, and the 
same time must be allowed them again to subside. 
Thus the patient, by injudicious practice, is often 
tortured for many months. ti\,e^«n^f 

The attempt then to introduce a bougie, for the 
dilatation of a spasmodic stricture, particularly if 
violent, before the application of external and in- 
ternal medicines have been made to prepare the 
parts for such an application, must be attended with 
most excruciating pain, and will scarcely ever re- 
move the affection. On the contrary, as just stated, 
the disease has often been rendered infinitely worse, 
and this at length has given rise to the existence of 
permanent stricture, when the application of the 
caustic has been in numerous instances, for then- 
removal, necessarily adopted. 

It may therefore be considered as a general rule, that 
the application even of the common bougie, without 
previously adopting those plans which must prepare 
the system in general, and the urethra as a part of 



201 

the whole, for its application, must always increase 
the irritable state of that canal, and consequently 
increase the disease. This is a point to which we 
cannot pay too much attention. 

As one proof that it is not the number of medi- 
cines, but the order and method in which they are 
applied, that are most beneficial in the removal of 
of spasmodic stricture, I may mention, that previ- 
ous to my having arranged them, as I now do, I 
was in the habit of applying all the different arti- 
cles recommended by authors, in the usual confused 
and indiscriminate way ; but never, unless in slight 
cases, effected any permanently good purpose. My 
experience, however, now warrants me to vouch for 
the effects of these medicines, internally and exter- 
nally applied, as thus referred to, in the removal 
even of some of the cases which I had formerly 
failed in curing. 

It is not, then, from a vast variety of external or 
internal medicines, without any order observed in 
their application, which, as already stated, is too of- 
ten the case in books written upon this subject, 
that we are to expect lasting or even temporary be- 
nefit. I know of no other complaint, where great- 
er discrimination is necessary, in the administration 
of remedies; a single error, indeed, may, even in 
the exhibition of the most useiul medicines, thwart 
all the advantages which would have arisen from 
the properly regulated employment of them. 

For the removal of spasmodic strictures, we must 
first, provided the patient be plethoric, employ ge- 
neral blood letting, and apply leeches to the part 
affected. At the same time, we ought to employ 
internally, as much camphor, opium, and aether, as 
the stomach can receive without producing sick- 
ness. After this, in from one to three or four days, 
according to the particular constitution of the pa- 
tient, a blister should be applied under the penis, 
or under the perinaeum, according to the situation 
of the stricture ; and it may sometimes be necessa- 



202 

ry to apply one of a pretty large size across the 
loins. After one or more of these have produced 
their escarotic effects, we may administer an injec- 
tion, per anam, of tobacco- smoke, or of laudanum 
and sether, and then lay the whole body for about 
ten minutes in a warm bath. After this, and while 
the patient still remains in the warm bath, we may 
inject a mixture of laudanum, oil, and aether, into 
the urethra, and, after dipping into the same mix- 
ture a bougie, or rather, if it be necessary to use it, 
while the patient remains in warm water, an elastic >. 
gum catheter, we, can scarcely I think, fail of pas- 
sing any spasmodic stricture that may have former- 
ly existed in that passage. I by no means propose 
that all these applications should be used at once, 
unless where a failure of one or more of them has 
has previously happened. The urethra is frequent- 
ly in such a state, that dilatation of stricture alone, 
after the properly regulated use of antispasmodics, 
and other applications of a similar nature, effects a 
- s complete cure. At other times, though not very 
frequently, these means will not of themselves com- 
plete the cure, and on such occasions we find it ne- 
cessary to use, in addition to the above, the various 
tonics in common use, with which, in no case that 
has yet come under my examination, have I ever 
failed in effecting a cure. In many cases I have 
used one, in others two or more, and in many, I 
• have been obliged to employ them all, and even to 
repeat them, before I effected my purpose. 

The preferable position for the patient's body to 
be placed in, for the introduction of the bougie, is 
on his back, with his knees somewhat bent. In 
standing during this operation, which is sometimes 
done, the parts are apt to be compressed by the action 
of the surrounding muscles, and in sitting, the ure- 
thra is very apt to be so completely compressed, as to 
prevent the possibility of introducing that instrument. 

I would pointedly object to the use of Mr Ch. 



203 

Bell's wire bougies with a silver knob, of various 
sizes, used to ascertain the distance of stricture from 
the orifice of the urethra. That canal is so liable , 
to spasmodic action, that however easily one of 
these bougies may be introduced to the distance 
the surgeon would wish, it must often be so firmly 
grasped by the spasmodic action, occasioned by 
its own introduction, as to prevent its being with- 
drawn without too much force being applied, or at 
least for a considerable length of time, till the spas- 
modic action has given way, either of itself, or by the 
application of remedies for that purpose. This fact 
is so evident, that I am sure it only requires to be , 
stated, that it may be at once perceived. 

I particularly wish it to be understood, that I 
conceive, and from practice I have proved, that 
when every means employed to relax a stricture, 
has, in some measure, failed of what we expected, 
the gentle pressure of a bougie upon its anterior 
part, the other means still being employed, will at 
length admit of one being pushed through it. This 
practice, of gently pressing on the anterior part, I 
prefer to even the smallest bougie being wedged in. 
the strictured portion itself; the first often assists 
in relaxing the part, while the later almost always 
makes the contraction worse. '-<- 

In some cases of this disease, even after the ob- 
struction has been removed, it is necessary to con- 
tinue the use of the bougie often a considerable . 
length of time. I even know some cases in which, 
independently of the very strictest attention to the 
state of the general system, as well as to that of re- 
laxing the individual parts, the use of the bougie 
has been occasionally worn for years ; and, unless 
it be introduced from time to time, the urethra 
contracts so as in some measure to obstruct the 
evacuation of the urine. In these cases, to satisfy 
all parties, the caustic bougie has been tried, but 
produced no permanently beneficial effects. Where 









204 

these obstinate cases occur, which has been but sel- 
dom, the occasional use of the bougie is the only 
alternative, and from it we can at all times com- 
mand temporary relief. A symptom, however, 
which sometimes occurs as producing such obsti- 
nate cases, ought to be mentioned ; that is, when 
the stricture is only the effect of a more serious dis- 
ease. When a bougie of considerable size can be 
passed, and still the stream of urine continues 
small, and the irritation is reproduced when it is 
omitted, we have reason to believe, that a general 
affection of the small glands^ though not so much 
so as to be felt externally, exists, cnusing a nar- 
rowing of the greater part of the canal of the ure- 
thra ; or that the same effect is produced by an en- 
largement of some of the parts, of considerable ex- 
tent under the membrane, so that this pressing 
upon it, the canal is narrowed for a considerable 
length. The bougie in such instances presses aside 
these enlargements, and allows the urine to flow 
freely ; but they resume their former state, and 
again the bougie must be had recourse to. Thus, 
although we are not able completely to remove the 
obstructing cause, even being able temporarily to re- 
move it is of very great importance. Thus, having the 
power of palliating such symptoms, by bringing away 
the urine on any pressing occasion, to prevent its 
detention inducing diseases of a still more dangerous 
nature, is of the very greatest service. In thus 
using the bougie, it ought to be withdrawn very 
slowly, while the patient is keeping up the effort of 
urining. Thus the stream follows close to the point 
of the bougie, and the force retains the opening the 
bougie had made for it. 

We are certainly much indebted to Mr Home, 
for having introduced more generally into practice, 
the use of the large in preference to the small bou- 
gie. Mr Sharpe, however, in page 183 of his cri- 
tical enquiry, was rather before him in his opinion, 



205 

respecting the comparative advantages of a large to 
those of a small instrument for that purpose. He 
says, " a large catheter or sound may sometimes 
be passed into the bladder when a small one can- 
not." The urethra being fully distended by the 
large instrument, allows it to pass easily, but with 
the small one, its progress is obstructed by the 
sides of the urethra entangling its point, and in al- 
most every instance preventing its free passage in- 
to the bladder. A small bougie, then, especially 
of the composition kind, ought never to be used, 
except where the passage, in conseqnence of dis- 
ease, cannot admit of a large one. In the first 
place, a small one scarcely ever passes so freely 
along the canal, as one of a larger size, and in the 
next place, it can never remain long enough in the 
urethra, to effect any beneficial purpose, till it be- 
comes quite soft and useless. 

But when, from the narrowness of the canal, a 
a large one cannot be used, a catgut one should be 
preferred to one of composition. They are less 
susceptible of such changes, even when used equal- 
ly small with the composition bougies. 

A small catgut bougie, then, when that sort of 
instrument is used, should be grasped by the finger 
and thumb of the operator, within an inch of its 
point, so that his finger and thumb may always be 
nearly close to the external orifice of the urethra. 
The bougie is often apt to be obstructed in its pas- 
sage by one of the lacunas, but by slightly shifting 
its situation, and, by elevating the point of it exter- 
nally by the other hand, it will be easily shifted in- 
to the cavity of the urethra. We must be particu- 
larly careful, in performing this operation, to use 
no force, as, by being rash, the instrument is apt to 
form a new passage for itself. Even the catgut 
bougie is, after a few minutes, apt to become soft ; it 
must then be withdrawn, wiped of its moisture and 
laid aside, and another employed. But if, previous to 



206 

this, it has passed the stricture, we do not require 
to withdraw it, for although it then becomes soft, 
it retains its situation, and by the swelling which 
moisture occasions in it, it assists farther to dilate 
the strictured part. The catgut bougie may be al- 
lowed, if necessary, to remain in the urethra any 
length of the time, as it does not stimulate the parts 
or produce any irritation. When the stricture is 
sufficiently dilated to admit of a larger sized bougie 
to pass it, it ought to be used instead of the catgut 
one. 

I am further decidedly of opinion, that no attempt 
ought ever to be made to introduce a straight bou- 
gie into the bladder, as, from the curve of the ure- 
thra, it is at all times liable to be obstructed in its 
passage, and in irritable habits it invariably throws 
the parts into a state of temporary contraction. 
The use of these, therefore, I have entirely laid 
aside, and I would warmly solicit others to do so 
likewise. In preference to these straight bougies, 
I gradually soften them, by applying a very gentle 
heat, and then bend them into the form of a com- 
mon catheter, which, when allowed to cool, I have 
always found to answer the purposes much better 
than any other form. 

Although, in the generality of cases of this dis- 
ease, when the system has been properly managed, 
there is no very great resistance to the introduction 
of a bougie, yet there are some of them, to which, 
even with attention to the above circumstances, 
considerable pressure must be applied before we can 
pass it into the bladder. If, however, much pain be 
occasioned during these trials, we ought not to per- 
sist in them, as, from that circumstance, the neces- 
sity of farther relaxing the parts, by internal medi- 
cines or external applications, is clearly indicated 
and absolutely necessary. 

The bougie is often stopt by the lacunae of the 
urethra, which, by those in the habit of expecting 



207 

permanent stricture, is mistaken for one ; and thus 
caustic is applied to barn a passage for the bougie, 
when neither spasmodic action of the parts, nor 
the smallest diminution of the canal of the urethra, 
exists ; at least till either one or other of these ef- 
fects has been caused by the above treatment. 

The preventing a bougie from rupturing the ca- 
nal of the urethra, and penetrating some of the 
neighbouring parts while passing into the bladder, 
requires both dexterity and considerable experience. 
Persons, however, would be apt to believe, were 
they not to think for themselves, that, from Mr 
Home's advice, the chances of getting out of the 
right road were not very uncommon, nay, except 
in the hands of the most stupid of the human race, 
almost impossible. This mode of attempting to 
render easy one of not the least important opera- 
tions in surgery, has, I am sure, made many a fool- 
hardy practitioner of that art, commit numerous, 
and in some instances, almost irreparable blunders. 
Because Mr Home, or any one in the daily habit 
of using the bougie, can perform this operation with 
ease, and describe and recommend it to others with 
ease stillgreater, these persons conceive it a shameful 
business to fail, and are consequently induced to 
poke, and squeeze, and thrust their instrument in- 
to any part but the right one ; and even when they 
fail, so convinced are they still of its being as easy 
as putting one's hand into a glove, that they have 
only to take the trouble to turn it off their should- 
ers, and conclude that there was some mal-con- 
formation of the parts, from which originated the 
difficulty. 

The most respectable authors who have written 
on strictures in the urethra, seem fully aware of the 
inconvenience, and even danger, attending a perse- 
verance in the use of the common bougie, when 
such an application occasions great pain. Some of 
them rest contented in expectation that a repetition 
of short trials will at length render the parts capa- 



203 

ble of being distended in this way ; while others, 
who however certainly do approach nearer the 
right method, prescribe a farago of internal and 
external applications, without that simplicity, order, 
or regularity for their administration, which alone 
can command a decided success. 

Mr Hunter, in page 122, was perfectly aware of 
the mischief arising from wedging, or thrusting a 
bougie too violently into the urethra, in order to 
remove obstructions by the process of ulceration. 
" I believe," say he, " there are few patients who 
will submit to this practice, and indeed few will be 
able to bear it ; for I have seen it bring on violent 
spasms in the part, which produced suppression of 
urine, and proved very troublesome." No doubt 
of it ; and it would be well, that an observance of 
various circumstances, to prevent such practice, 
were more closely attended to : then the excruciat- 
ing pains which a patient is doomed to bear, the 
unnecessary application of caustic, and the irreco- 
verably distorted urethra, which is often the conse- 
quence of it, would all be avoided. 

If, however, we should find it necessary in some 
cases to allow the bougie to remain in the urethra 
several hours, it will be absolutely necessary to fix 
it in some way, either to prevent its being pushed 
entirely out of the urethra, or, as sometimes hap- 
pens, to prevent its slipping into the bladder. For 
this purpose, ligatures put round the bougie, and 
fixed to the penis or the scrotum, &c. are recom- 
mended ; but I have found the least troublesome 
and most effectual way to be, to fix the end of the 
bougie into a piece of cork, or, by repeatedly dip- 
ping the end of it, before subjecting it to use, into 
melted sealing-wax, till it has acquired sufficient 
size to prevent the possibility of its slipping into the 
bladder. To this a piece of thread, or a bag like 
the finger of a glove, may be applied over the penis, 
to prevent the bougie from slipping out. 



'20^ 

A continuance, however, of bougies for a great 
length, of time, after the canal of the urethra has 
been distended to its natural width, seems to me at 
best questionable. For if the disposition to contrac* 
tion exists, in any violent degree, after this period, 
we may be assured, that local applications of any 
kind will riot remove it ; that the disease of the parts 
can only be permanently removed by the removal 
of the diseased action, which, as it very commonly 
arises from debility, must be treated by medicines 
which counteract it. I have seen such a state fre- 
quently attended with considerable pain, giving rise 
in the mind of some more versant in the theory, than 
in the actual practice of such complaints, to a sup- 
position of its existing in consequence of inflammation. 
In such cases, however, I have employed cantharides 
internally with the greatest benefit. 

In some cases, I may remark, of retention of urine, 
from whatever cause, there often originates in the 
urethra the most violent spasm, to remove which, 
the evacuation of urine is alone necessary. For this 
purpose, Surgeons have been in the habit of punc- 
turing the bladder in different places, sometimes 
above the pubis, sometimes in the perinaeum, and at 
other times by the rectum. Either of these opera- 
tion usually relaxed the spasmodic action of the ure- 
thra, and the urine flowed in the natural way ; but 
certainly a fair trial of internal medicines and exter- 
nal applications, as long as we can with safety delay 
puncturing the bladder, with properly regulated at- 
tempts to introduce a catheter or bougie, have not 
been made, and where other means were successful, 
the operation would have been by these means nei- 
ther so hazardous nor so formidable. 

CASE. 

On the 25th of August, 1807, f, for the first 
time, visited a Gentleman, aged 50, who, after hav- 
o 



210 

ing exposed himself to cold and dampness, while in 
a state of intoxication, was, in a few hours after, af- 
fected with some difficulty of voiding urine, rapidly 
increasing in severity 

On the 26th, he became much alarmed, and I 
ordered for him pills, composed of camphor and 
opium, a scruple of camphor and two grains of opium 
to be taken daily. On the same evening, he passed 
urine in a full stream. To prevent constipation from 
the operation of the medicine, I likewise ordered him 
to use a laxative pill every night at bed time. 

On the 30th, as the opium produced very obsti- 
nate constipation, I ordered him to omit it, and to 
take the camphor by itself. 

Till the 7th of September, he had no return of his 
complaint, except early that morning, when he was 
most violently seized by it. He said, that, on the 
previous evening, being warm and fatigued, he had 
drank, very rapidly, about two pints of porter, and, 
in about two hours after, he experienced a difficulty 
in voiding urine. He, on the same evening, felt as 
if his urine flowed easily along the urethra, till it 
came to about half an inch from the orifice, where 
it stopped 5 and, immediately after, he felt the most 
excruciating pain darting along the whole course of 
the urethra. The spasm was so violent, that, without 
tearing the parts, neither a bougie nor catheter could 
be introduced ; and as the principal obstruction 
seemed to be near the external orifice, I ordered, in 
addition to the camphor pills, a blister to be applied 
along the under part of the penis, from the scrotum 
forward, which entirely removed the obstruction, 
and he again passed urine freely and without pain. 
He observed, that a draught of cold liquor, particu- 
larly if fermented, always brought on an attack of 
this complaint, and that the camphor pills, with the 
warm bath, as regularly removed it. His whole sys- 
tem now became very irritable, and the slightest ex- 
posure to irregularity in living, brought back the 



211 

symptoms of his complaint, at least, in a slight 
degree 

About midnight on the iQth, he was seized with 
almost complete retention of urine, which caused in- 
describable uneasiness, and at J o'clock of the fol- 
lowing morning, when I was sent for, he could not 
void a drop of urine, and was nearly in a state of de- 
lirium. His bladder, however, was not distended ; 
but, from time to time, he felt the greatest inclina- 
tion to void urine, without the power of passing a 
drop. His pulse being very full, I took from him 
two pounds of blood, which exhibited strong marks 
of an inflammatory diathesis. 1 likewise ordered him 
a cathartic, and applied a sinapism to the perinseum, 
and a large blister over his sacrum. In two hours 
after, his water came away in drops, attended with 
the most excruciating pain ; and in 12 hours from 
the time I visited him, he had voided two ounces of 
urine. His pulse still continued full and strong, and 
I now took from him an additional pound and a half 
of blood ; in an hour after, he voided urine with more 
freedom tnan he had done for many hours before, 
though it still was attended with considerable pain 

On the 2 1st, the blister on the sacrum rose well, 
and he then voided urine with as much ease as if in 
perfect health. His pulse, however* was still very 
full. On that morning, while voiding urine, he made 
an attempt completely to empty his bladder, and, 
immediately after this, he experienced a recurrence 
of the spasm. To prevent this in future, 1 desired 
him to make no such exertion, and ordered the ca- 
thartic to be repeated. 

On the morning of the 25th< I found this patient 
in great agitation of mind from the dread that his 
complaint was about to resume its former violence. 
He now felt an almost constant inclination to void 
urine, which unifjrmly came on almost immedi- 
ately after a violent passion of the mind on the pre- 
ceding night, but had nearly gone off again, when, 
02 



212 

during this night, he had an involuntary emission of 
semen, and was immediately seized in this way. I 
desired him to inject some oil into the urethra, and, 
after taking a cathartic, to recommence the camphor 
pills as formerly directed. Before the evening of the 
same day, he voided urine freely, and in a full stream. 
On the morning of the 2/th, another seminal 
emission took place, which was immediately followed 
by a slight attack of the spasm. 

On the 28th he followed the same plan as on the 
25 th, and was again well. 

On the 5th of October, I made an attempt to in- 
troduce a bougie, but this could not be done with- 
out injuring the parts. The attempt was followed 
by partial spasmodic contractions of the urethra, and 
slight soreness in it for several days after. 

On the 18th, after an attempt to introduce a ca- 
theter, which could not be put even within the ori- 
fice of the urethra, the spasmodic affection returned. 
A blister was therefore immediately applied to the 
perinaeum, and a cathartic prescribed. 

On the 20th, a large sized bougie was introduced 
as far as two inches, but would pass no further : it 
occasioned no pain, and was therefore allowed to re- 
main several hours, when it was withdrawn, and the 
urine flowed in a full stream. 

On the 2 i st, a catheter of a large size was intro- 
duced as far as seven inches, and being withdrawn, 
a large sized bougie was then introduced and allowed 
to remain a few hours. It occasioned only slight 
pain at the orifice of the urethra, and, when with- 
drawn, the urine then also flowed in a full stream. 
A slight puriform discharge was at the same time 
observable, and he had a fit of shivering during the 
night, which greatly alarmed him. 

On the 22d, he continued feverish, and could not 
void a drop of urine ; a blister was therefore applied 
over the pubis, but neither catheter nor bougie could 
be introduced. 



213 

On the 23d, he passed urine in drops, and some- 
times in a very small stream, which was attended 
with great pain along the urethra ; I therefore de- 
sired the cathartic to be repeated. 

On the 24th, a large bougie was introduced, which 
stopped at one inch and a half from the orifice of 
the urethra ; that however easily gave way, and it 
passed without interruption about six inches, where 
it was allowed to remain. 

On the 25th, on withdrawing the bougie during 
the night, the urine flowed in a full stream, followed 
by a slight puriform discharge. It was then again 
introduced, and it stopped at the same place. 

Early on the morning of the 26th, being affected 
with violent shiverings, he withdrew the bougie ; 
they soon went off, and he passed urine with ease, 
and in a full stream. 

On the 27th, he himself, with the greatest ease, in- 
troduced the largest bougie for seven inches and a 
half, and permitted it to remain almost constantly 
till the following morning, when the shivering fit 
came on, and he withdrew it. The fit continued for 
several hours, although he applied warm fomenta- 
tions, and had an injection wjth tinctura opii admi- 
nistered per anum. 

On the 2C)th, with only a slight obstruction at two 
inches, the largest bougie passed easily for seven, but 
could not be introduced further. A. small cat-gut 
bougie was, however, passed into the bladder. 

On the 31st, every time he withdrew the bougie, 
(and it was this day introducod to within an inch of 
the neck of the bladder) the urine flowed in a full 
stream. 

On the 2d of November, he felt sick, and had a. 
slight shivering fit. I however passed a full sized 
bougie into his bladder, without experiencing any 
remarkable obstruction. It excited severe pain, par- 
ticularly about the glans, and when it was withdrawn 
3o 



ai4 

an hour afterward, the urine flowed freely, and in a 
full stream. 

On the night of the 4th, he slept very little, and 
did not void urine so freely as the day before. The 
bougie was not again introduced till the 5th, when 
it was besmeared with tinctura opii and oil, and 
passed easily into the bladder without any other ob- 
struction than a slight one at the orifice of the urethra. 

From time to time this spasmodic affection return- 
ed, in a slight degree, for about six weeks, but ne r 
ver so severely as to prevent him from having a ca- 
theter, or a full sized bougie introduced into the 
bladder when found necessary. 

It is to be remembered that the camphor, some- 
times with opium, was continued during the whole 
of this case. 

Hp has never (Sept. 18oQ,) had any return of his 
complaint. 

CASE. 

July 1807. A Gentleman, aged 35, of* a dark 
complexion, and very stout, applied to me about 
two years before this period for the removal of a 
gleet, which he conceived to depend on permanent 
stricture in the urethra In answer to the questions 
I then put, he informed me, that although the stream 
of urine was of a full size, it had assumed various ir- 
regular shapes, which it never had before he was 
affected with this complaint ; but, that he passed it 
without any pain or uneasiness. This varied state 
of the stream of urine gave me reason to believe that 
no permanent stricture existed in his urethra, and 
that it was only a spasmodic affection in consequence 
of gonorrhaea with which he had been frequently 
troubled. 

I did not introduce a bougie to ascertain what 
seemed so obvious, viz. that there was no permanent 
stricture present. 1 therefore prescribed for him the 



215 

tincture ofcantharides,buthe used it irregularly, hav- 
ing very little hope of being benefited by it. He soon 
after went to reside in London, and, anxious about the 
state of his complaints, he assiduously perused every 
book he could find that treated of strictures in the 
urethra ; and from them having determined to use the 
caustic, he immediately consulteda surgeon, who judi- 
ciously advised him to begin with the daily use of the 
simple bougie, which was easily introduced into the 
urethra, and after a few attempts, one of the largest 
size was passed into the bladder. About two weeks 
after the introduction of the largest bougie into the 
bladder, the discharge from the urethra increased in 
quantity, and became somewhat puriform ; and, upon 
pressure being applied, he could feel constrictions in 
various parts of the urethra, which he never felt be- 
fore the bougie was introduced. He was now as- 
sured by his medical attendant, that the caustic 
bougie alone could be of service to him, and that 
from its use he might expect a complete cure. It 
was accordingly had recourse to. The first applica- 
tion gave him considerable pain, but it completely 
removed one obstruction, situated about an inch from 
the external orifice of the urethra. Considerable in- 
flammation of the glans penis, with blueness and 
swelling of the prepuce followed in a few hours, and 
the discharge, during the following day, was thick 
and yellow, and in very great quantity. An eruption 
then broke out over his body, and watery blotches and 
great swelling of his face and head, troubled him for 
several hours. This, with the blueness and swelling, 
abated in about two days, and the caustic was again 
applied ; but what puzzled the gentleman was the 
formation of a new stricture, nearly on the same spot 
where the one existed previous to the first application 
of the caustic. This was also destroyed, and the 
same effects followed as an the former occasion. By 
the application of the caustic bougie four times a- 
week, for seven months, every obstruction, from the 

o4 



216 

external orifice of the urethra to the bladder, Was 
destroyed ; and all that time, a very great degree of 
inflammation was preserved in the parts, and conse- 
quently a puriform discharge^ As new strictures 
were forming almost as quickly as they could be de- 
stroyed by caustic, he imbibed a notion that he was 
constitutionally subject to permanent stricture. At 
the expiration of seven months, the whole course of 
the urethra was so much contracted, and the penis 
incurvated to such a degree, that he could not, with- 
out the greatest difficulty, introduce the very smal- 
lest caustic bougie. This was a source of much un- 
happiness to him, as he now found, that the intro- 
duction of this instrument was absolutely necessaay, 
in order that a passage might be formed for the eva- 
cuation of his urine ; and, from the great quantity 
of puriform matter which was discharged immedi- 
ately after each application of the caustic, he con- 
ceived that a collection of pus had for a considerable 
length of time been daily forming near the neck of 
the bladder, for the necessary evacuation of which 
the caustic alone was useful. This deplorable 
practice was at length luckily discontinued, and the 
use of the smallest simple bougie resumed, and in 
two, or nearly three months more, he observed that 
the discharge from the urethra had disappeared* 
Thus was he unintentionally cured of his gleet. As 
the spasmodic affection of the urethra, however, still 
continued, I desired him to use, for a short time, 
camphor and opium in pretty large doses, and after- 
ward to keep the parts gently distended by the sim- 
ple bougie. He then, for several weeks, adopted 
this practice, and experienced the greatest benefit 
from it. 

He now says he never shall again use the caustic, 
as he is convinced it was owing to it that he had 
suffered so much ; but the abettors of this practice 
wssure him that, however much he may have suffer- 
»ed, he would have suffered more, had he never used 



217 

it, and that in expressing his opinions of the caustic 
bougies, he will only be ridiculed by the world, and 
pan effect no other purpose. 

CASE. 

A Gentleman, aged 42, and very stout, was, four 
years ago, suddenly affected with violent retching, 
particularly when he coughed, to which he was very 
subject, or When he suddenly stooped forward. He, 
at that time, took medicines for the removal of these 
complaints, and was in a few weeks almost complete- 
ly cured ; but when he indulged in his bottle, the 
retching uniformly recurred, and continued to dis- 
tress him for several weeks. 

I was sen' for in December 1806, to prescribe for 
a severe, hard, dry cough, with which he had been 
very much troubled for some time. He had no pain 
in his chest, and his bowels being costive. I pre- 
scribed a cathartic, and ordered him squill pills. I 
likewise desired him to inhale, from a coffee or tea- 
pot, the steams of vinegar and warm water every 
pight ; but when he attempted to do this, the retch- 
ing became very troublesome, and he was obliged to 
desist. Within these few days, he had felt slight 
pain about an inch from the orifice of the urethra, 
but as this affection was attended with very little in- 
convenience, 1 did not order any medicine for its re- 
moval. He had, for sometime past, frequently been 
obliged, from torpidity in his bowels, to take cathar- 
tics ; and he always observed that the sensation in 
jthe urethra became more painful during the opera- 
lion of such medicines. After he had continued 
the use of the squill pills for a week, without any 
diminution in the severity of his cough, it was deem- 
ed necessary to apply a pretty large blister to his 
breast, which was kept open with ung. epispast. ; 
but even this, along with the squill pills, &c. did not 
seem to relieve his cough and retching in the smallest 



218 

degree for more than a fortnight, when both these 
affections became less violent. 

He was, on the evening of the 12th of January, 
1807, affected with considerable difficulty in void- 
ing urine, for which, altho' he applied clothes wet 
in warm water for several hours to the pubes and 
perineum, it still continued to increase in severity. 
At length, however, he became much easier, and 
slept quietly till toward morning. On examining 
the urine he had past during the night, I found it 
completely coagulated like jelly, and he said it had 
the same appearance on the preceding night, previ- 
ous to his going to bed, which alarmed him greatly. 
He never had any venereal complaint. 

I prescribed for him pills principally composed of 
camphor with a small proportion of opium, so that 
about a scruple of the camphor might be taken daily, 
and I ordered a blister to be applied to the perineum. 

On the 14th of January, the blister had not re- 
mained many hours, when he was much relieved, 
and voided urine freely, and oftener than once during 
the night, which had not, as formerly, the coagula- 
ted appearance. The pain in the urethra had abated, 
and the other complaints were getting better. 

On the 20th, when the gelatinous appearance was 
not present, his urine deposited a great quantity of 
brown sediment ; but when the urine was gelutinous, 
it was free from sediment : and when the retching or 
cough was severe, the pain and difficulty in voiding 
urine cease, and uniformly became more severe 
when the cough, &c. ceased. 

On the 27 th, he had a slight return of the spas- 
modic affection ; but it went off in a few hours, with- 
out his having occasion to use any remedy. 

On the 5th of February, in consequence of his 
complaints in the urethra having returned with con- 
siderable violence, he had again been obliged to ap- 
ply the blister to the perineum, which had again re- 
lieved him \ but immediately after, the cough and 



210 

retching, as usual, commenced Another blister 
was applied to his thorax, and I desired that both of 
them might be kept open with epispastic ointment. 
In ten days after this, the blister in the perineum 
healed, but that on the breast was kept open. 

In May, rone of his complaints had troubled him, 
and I desired him to allow the blister on his breast 
to heal. In September 180Q he had no return of his 
complaints, and he enjoyed a state of excellent health. 



Of Permanent Stricture. 

More than an hundred years ago, the application 
of caustic to the urethra was by no means an un- 
common practice. It was soon after, however, laid 
aside by general consent ; yet, during that period, 
we are not assured that the existence, either of 
permanent or spasmodic contraction in the urethra, 
was more common in consequence of laying aside 
the caustic ; but, on the contrary, it would seem, 
from authors saying little on the subject, to have 
been less so in early times, when the caustic was 
unemployed, than in the present day, when the 
caustic cannot be wanted. Indeed, such is our pre- 
sent rage for that practice, that one can scarcely 
walk into a country apothecary's shop, but he can 
tell you wonders, (and I have no doubt of it), that 
he has wrought with it It is sincerely to be hop- 
ed, for the benefit of mankind, that it will soon 
again be laid aside, except when absolutely neces- 
sary, which is very seldom. 

The liberties which, upon this, subject, Mr Home 
has taken with Mr Hunter's name, are greater than 
we might have expected. That gentleman's opi- 
nion respecting the application of the caustic for 
the removal of stricture was, though perhaps in 
some respects erroneous, much more scientific, less 
common, and, in a great measure, different from 



220 

the views of Mr Home on the same subject. Mr 
Hunter says, in page 118 of his book on the vene- 
real disease, " If the case is such as to admit the 
end of a small bougie to pass, let it be ever so small, 
the cure is thus in our power." Mr Hunter thus 
found, that such cases were remediable, but he 
wanted a knowledge of the means by which he 
could have effected this purpose. Were, however, 
the gentlemen who have lately practised in this way, 
as scientific in their views respecting many points 
in the animal economy as Mr Hunter, many who 
suffer by the effects of the caustic bougie, might 
now be in tolerably good health. 

The progress of Mr Home's practice, at least 
that part of it which he has ushered into the world, 
as a proof of the correctness of his reasoning, and 
of the simplicity and ease of such practice, is as fol-r 
lows : — His first essay was upon a small scale, and 
simple enough ; from Mr Hunter's respectability 
he gained applause, or at least, from that circum- 
stance, he, on that occasion, escaped reprobation ; 
he ventured a little farther ; proposed something in 
addition ; but still, for the most part, on such occa- 
sions, he took care to shelter himself under the wing 
of Mr Hunter's well-earned reputation ; till at last, 
finding himself pretty nearly in a way that he thought 
warranted him to speak and act entirely for himself, 
he boldly asserted, that many of the more impor- 
tant diseases ascribed by nosologists to other causes, 
depend entirely on stricture in the urethra. 

I give the consulting surgeons of London, in ge- 
neral, every credit for the superiority of their powers 
in the performance of the most difficult operations. 
Indeed, I believe, that at present they are, with the 
exception of one or two individuals, superior in that 
respect to any in the world. But in the discrimination, 
of diseases, I would reverse the statement ; for I really 
think, that the proportion of them who can do this, 
well, is not so great as might naturally be expected. 



221 

Medical men, with their hands combined with the 
heads of some of those in other parts of the world, 
would have the most decided success, as well in rea- 
soning, as in the performance of many operations, 
which, in their divided state, are but clumsily ma- 
naged. 

Mr Sharpe, I may observe, when treating of the 
subject of strictures in the urethra, informs us, 
that " at present, it (the caustic) is universally con- 
demned, and has been so almost since Saviard's 
time. His objections to the use of caustics, were 
the difficulty and almost impossibility of directing 
them, "so as to eat through all the diseased parts of 
the urethra, without destroying the sound parts ; 
the impracticability of preventing the urethra from 
contracting when it healed, as much if not more than 
it was at the time of applying the escarotic,' &c." 
To the authority of Sharpe and Saviard, against the 
indiscriminate use of caustic, I may add that 
of Pare, Wiseman, Le Dran, Astruc, Pott, and ma- 
ny others, whose respectability and eminence can- 
not be questioned. These objections may with 
equal justice be always urged against this practice, 
even where parmanent strictures are formed, and 
far more so when we find it indiscriminately appli- 
ed, where there is no permanent stricture at all ; 
nor will even the authority of Mr Home, for the 
eaqe, attending its application, and its safety, over- 
turn them. The authorities quoted, to men who 
know how to reason, have always been as good as 
Mr Home's, and will probably remain as long so. 

Mr Whately has, in his defence of the applica- 
tion of caustic, attempted to draw a comparison be- 
tween its effects and that of the more active medi- 
cines used internally ; but the comparison is not 
fair ; we can dilute the medicines, and use them in 
any quantity we wish, but we must use the caustic 
in full quantity, and in its greatest strength and ac- 
tivity. 



222 

This gentleman, however, has, in his pamphlet 
©n Mr Home's practice, given a very neat con- 
densed view of the effect of Mr Home's bougies, in 
his treatment by caustic of obstructions in the ure- 
thra. His criticisms seem correct, and are certain- 
ly those of a gentleman and a man of liberality ; 
yet even he, in some of the cases subjoined to these 
criticisms, has used the caustic in pure spasmodic 
stricture, and consequently subjected the patient to 
much unnecessary distress. Mr Whately justly ob- 
jects to Mr Home's introducing the caustic bou- 
gie into the bladder, from the chances of carrying 
along with it, and depositing in that viscus, any of 
the liquified caustic. This is an objection which 
certainly deserves consideration. 

In a note in page 36, of Mr Wadd's pamphlet, 
he informs us, that " to a gentleman, with whom 
he was well acquainted, it (the caustic) was applied 
upwards of fifty times to a supposed stricture near 
the neck of the bladder. When he died, the ob-> 
struction was discovered to have arisen from an en- 
larged prostate gland. The caustic had eaten an 
inch into the substance of the glands Many other 
instances of a similar kind, he informs us, might be 
enumerated. Yet it is passing strange, that on 
reading Mr Home's book, we find the application 
of the caustic neither occasions pain to the patient, 
nor difficulty to the surgeon. 

Communications which I have lately had from 
many parts of the country, respecting these diseases 
of the generative organs, proves, that the caustic 
bougie had in them not only been unsuccessfully 
applied, but had, in some instances, created the 
most afflicting and irremediable distress, to which it 
was possible to reduce an unfortunate patient. In 
others, where this practice was not carried so far, I 
have easily removed their complaints by the in- 
stantaneous adoption of more simple means. 

Even allowing all the cases Mr Home oper- 



223 

ated for with his caustic bougies, to have been 
permanent strictures, the frequent recurrence of af- 
fection, always in an aggravated degree, and the ne- 
cessity there was, in some instances, of applying the 
caustic often for a great succession of years, (several 
hundred times in some instances,) completely prove, 
that from such an application, we have no right to 
expect a radical cure, except in the very slightest 
cases, and that only, when the contracting power 
has quite abated. 

Were no other mischief to follow the application 
of caustic to the urethra, but the excessive hemor- 
rhage, which is confessed, even by authors who are 
advocates for this barbarous practice, to be a very 
frequent occurrence, that alone would deter any one 
from its constant use. These authors, however, 
talk with much coolness, even when six or eight 
pounds of blood have been discharged in this way. 
Various cases are related by them of the ease and 
safety of such bleeding. Mr Wadd, however, very 
properly takes another view of the subject : " In 
one case," says he, " after the eighth application of 
the caustic, on withdrawing the bougie, i was in- 
stantly covered with blood, which came out, with a 
jet, nearly equal to the flow of urine. I must con- 
fess, whatever those accustomed to such accidents 
may think of it, that I was greatly alarmed ; and 
as it happened in my own house, it was the more 
embarrassing ; pressure and cold applications were 
used in vain, and it was some hours before it became 
sufficiently moderated to allow the patient to be car- 
ried home in a sedan chair. The bleeding continu- 
ed at intervals, for several days ; and it was Jive 
months before the patient, who was a foreman in a 
manufactory, had recovered his strength sufficiently 
to resume his station." A However far," Mr Wadd 
properly remarks, " habit may teach a surgeon to 
regard these circumstances with indifference he will 
not so easily succeed in making the patient, or his 



224 

friends believe there is no dan ger, and that extreme 
debility is a matter of no consequence." 

Mr Carlisle informs us, in the 3d volume of the 
Medical and Physical Journal ; that a young gen- 
tleman, to whom he applied caustic for a stricture, 
near the bulbous part of the urethra, had a hemor- 
rahge produced by it, which continued seven days ; 
in the two first, he lost four pounds of blood, and 
nearly as much afterwards. Mr C. has v heard of 
some other persons who have actually died of this 
kind of hemorrhage. 

Strictures, however, of a truly permanent nature, 
can only be removed by the various modes recom- 
mended by authors for their entire destruction ; 
such as the various ways of applying caustic sub- 
stances, and even some may probably require incU 
sion. 

Mr Hunter conceived the caustic properly appli- 
ed, only under the following circumstances : if First, 
where the stricture is so tight, as not to admit the 
smallest bougie to pass Secondly, where the ori- 
fice in the stricture is not in a line with the urethra. 
Thirdly, where the passage has been obliterated by 
disease, and the urine passes by fistulae in perincea." 
Had Mr Home followed Mr Hunter in these plans 
of practice, and not taken him along with him, as 
he always does, merely to support him in his diffi- 
culties, he would perhaps have prevented many an 
unnecessary scene of misery to several unfortunate 
individuals. 

I have found, that where permanent stricture ac- 
tually existed, and where it was absolutely necessa- 
ry to apply some substance for its removal, the mode 
either for application of the lunar caustic, or the ka~ 
li purum, as recommended by Mr Whately, is pre- 
ferable to any other with which we are at present 
acquainted. The first of these substances is secured 
in the form of powder, to the end of a bougie, by 
means of common glue, and before being applied 



225 

to the obstruction, has a thin covering- of bees wax 
laid over it The other is introduced into a hole, 
about the size of a pin's head, made in a common 
bougie, and covered with hogs lard 1 ither of these 
substances, when applied for a short time to the 
stricrure, is dissolved, and produces its effects by de- 
stroying it. In this way, the membrame of ti,e ure- 
thra is not so liable to be injured, as in the other 
modes of applying caustic substances; but still it 
must, in many instances, suffer ; for when the caus- 
tic becomes liquified, the disposition of all matter, 
and these in common with others, to run toward 
the orifice of the urethra, must greatly injure or 
entirely destroy the membrane, anterior to the stric- 
ture. 

Even, however, where it has beyond doubt been 
ascertained, that permanent strictures exist, the use of 
internal medicines and external applications, during 
our attempts to remove them, are absolutely neces- 
sary. Because, in all such strictures, even of a per- 
manent nature, there is, according to the time they 
have existed, some degree of spasmodic action still 
remaining in them, which, in almost every instance, 
cannot suffer dilatation without these applications 
being previously made. 

Still, any contrivance, however ingenious, for the 
application of caustic to strictures, must be liable 
to the insurmountable objection mentioned above. 
What I allude to, is the impossibility of preventing 
the caustic, liquified by the moisture of the parts, 
from spreading over and destroying an extensive and 
healthy surface, particularly anterior to the obstruc- 
tion. This, apply the caus : ic in what way we may, 
cannot be avoided ; and this ought, with other very 
forcible reasons, to deter us from using it, unless where 
the most unequivocal marks ot pamanenc stric ure 
really exists. Even allowing the caustic to be ap- 
plied in the most favourable- way, the difficulty of 
destroying the obstruction without force is greater 
p 



22(5 

than is commonly imagined. Under these circum- 
stances, it labours under double the disadvantages 
of the common bougie, even when applied in the 
rudest manner ; the force used in both is equally 
great, and, inert as the caustic may be rendered by 
the mucus of the urethra, which may prevent ic 
from burning through a hardened and thickened 
stricture, it is still sufficiently active to injure, if not 
destroy, the delicate membrane anterior to the stric- 
tured part. 

Fistula in perinaso, I believe to be sometimes oc- 
casioned by obstructions in the urethra, either of a 
spasmodic or of a permanent nature ; but I have no 
hesitation in asserting, that the increased action 
brought upon the parts by perseverance in the use 
of the caustic, or even the bougie, for a great length 
of time, has been a more frequent cause of this dis- 
ease, than either of the above. 

When stricture in the urethra, either of a spas- 
modic or permanent nature, occasions a swelling in 
one or both testicles, this obstruction acts like a fo- 
reign substance in these parts ; similarly to the use 
of too strong injections, which are very commonly 
the cause of the same complaint. The cause being 
withdrawn or removed, the testicles resume their 
healthy action, which, while it remains, no applica- 
tions to these glands themselves can effect. Al- 
though, therefore, this should be the case, it does 
not, as is too often supposed, entitle any one, on 
the appearance of a swelled testicle, to thrust a 
bougie into the urethra, which can only cause spasm 
of these parts, which did not exist before, and to 
term this permanent stricture, and then to apply 
caustic for its removal. The properly regulated 
use of the bougie, even if spasm had previously ex- 
isted, might have answered all useful purposes — I 
say the properly regulated Use of the bougie : I do 
not mean its indiscriminate application ; for in this 
unmethodical way of applying it, the swelling of the 



227 

testicle, so far from being removed, is often increased, 
and is more frequently produced by it. 

In this place I dec ine giving a number of cases. 
The arguments I have used, and the opinions I have 
formed are here presented in a condensed view from 
the general range of those cases, which have, for years 
past, come under my observation. 



p 2 



228 



TREATMENT OF FISTULA IN PERIN(EA. 



When a collection of matter forms in the peri- 
nceum, we ought to open the tumour as soon as 
fluctuation is distinctly felt in it, and, after also lay- 
ing open any small sinuses to prevent collections of 
matter, we may dress the sore by any stimulating 
ointment. In these, indeed, as in all other sinous 
openings, it is necessary to lay them freely open, 
this means, provided there exist no obstructions, 
&-c. as exciting causes, the sores heal very rapidly. 
But if a fistula has been of long standing, it is rea- 
sonable to believe, that the parts will not so soon 
recover healthy functions as when the fistula has 
lately commenced. The case may be a little more 
tedious, but when the callosities are obstinate, they 
may be dissected away or destroyed by caustic. 
When the irritation, which is sometimes produced 
by the operation, has subsided, we may occasionally 
introduce a bougie or catheter into the urethra or 
bladder, and, in a short time, the urine will come off 
by the natural passage. 

Our next object is to pass a bougie along the ure- 
thra, and when this instrument can with facility be 
introduced into the bladder, it will be known whe- 
ther the obstructing cause exists exterior or poste- 
rior to the opening, and we can proceed with our 
means of relief accordingly. 

Where, then, this disease exists in consequence 
of obstructions in the urethra, they are commonly 
anterior to it, and ought first of all to be removed, 
before we even attempt to cure the fistula by any 



229 

other means. This obstruction alone being remo- 
ved, often cures the complaint. 

When this disease exists, in consequence of an 
affection of the general system, such as lues vene- 
rea, external applications, bougies, &c. can be of 
no service. We must either, in combination with 
or without them, use means for the destruction of 
the venereal taint in the body, and the sinuses will 
then easily heal. 

In that alarming and often fatal complaint, — a 
dffiusion of urine in the body of the penis, we ought 
to be very prompt in our actions, as every moment 
is precious in the treatment of such a disease. Our 
first object should be to puncture the bladder, and 
preserve the opening, so as to prevent an accumu- 
lation of urine in the penis ; and then, by scarify- 
ing the parts, with occasional pressure, we may eva- 
cuate what has been already collected. The dispo- 
sition to mortification being very strong in this f 
complaint, spirituous fermentations/ and the inter-' 
nal use of bark, ought, during the whole course of 
it, to be freely administered. 



P3 



230 

CHAP HI. 

TREATMENT OF FEMALE ORGANS. 



Of Leucorrhcea. 



Here t shall endeavour to point out specifically 
those varieties of this complaint, and those occur- 
rences and circumstances which demand a change or 
difference in the treatment. 

All the medicines in the ancient or modem 
Pharmacopoeias, and all other means, which either 
the caprice of the physician, or the predominance 
of the theoretical doctrines of any age could sug- 
gest, have, one might affirm almost without excep- 
tion, been ineffectually employed to remove leu- 
corrhoea. 

But the substances which have deservedly main- 
tained their character, as being most frequently use- 
ful, are the various preparations and vegetable prp- 
ductions denominated tonics, with the use, at the 
same time, of cold lavation, and astringent injec- 
tions. In very high repute are the balsams, and the 
cantharides are said to be sometimes successful. 

* « As the leucorrhcea," says Cullen, " general- 
ly depends upon a great loss of tone in the vessels 
of the uterus, the disease has been relieved, and 
sometimes cured, by certain stimulant medicines, 
which are commonly determined to the urinary pas- 
sages ; and, from the vicinity of these, are oftes 

* Cullen's Practice, Vol. II. p. 12. 



231 

communicated to the uterus. Such, for example, 
are cantharides, turpentines, and other balsams of a 
similar nature." 

If we attend to the facts concerning leucorrhcca, 
which daily obtrude upon our observation, we shall 
find an easy explanation of that success and failure. 

The complaint originates in an almost infinite 
variety of circumstances, and exists in every degree. 
Sometimes there is an attack of it from occasional 
grief or alarm, which spontaneously goes off, after 
a few days continuance ; whatever remedies arc 
used in such a case, seem successful. 

In a family where I sometime since attended, a 
lady, much shocked at the death of a child, was 
seized with a most violent attack of hysteria ; it 
continued, with little intermissions, for 24 hours ; 
when the hysteria went off, a very copious leucor- 
rhceal discharge began to flow; this went off in two 
days, and was immediately succeeded by a renewal 
of the hysteria, which was much less violent than 
the former, and went off gradually ; nor did the leu- 
corrhcea return. 

This lady's menstruation had returned at shorter 
intervals, been more copious, and of longer duration, 
for the previous twelve months than formerly ; and 
she had been subject to slight attacks of hysteria, 
but not to leucorrhcca. 

I have found, after a copious menstruation, that 
leucorrhcea came on with dyspepsia, diarrhoea, and 
fainting ; and this was completely removed by ca- 
thartics, followed for a few days by the moderate 
use of wine and bark. 

In other instances I have met with this com- 
plaint, even of considerable duration and obstinacy ; 
not accompanied, however, with much debility ot 
the general habit, but great constipation, and other 
symptoms of dyspepsia. 

This also has completely yielded to the use of 
the most powerful cathartics ; a pretty severe hys- 
p 4 



teria disappeared along with it, and the appetite re- 
turned, without any other means being employed. 

Sometimes in young women, particularly servant 
girls, who have been subjected to cold in washing, 
during the flow of the menses, these have stopt sud- 
denly ; headach, pain in the loins, and general un- 
easiness have come on, with a flow of high coloured 
urine, and a punform discharge from the urethra. 
This is removed by smart purging and diluent 
dri ks, with /cold lavation. / iyy : %. 9A k , h t flk&iiU> 

In one or two instances, I succeeded dv copious 
venesection along with these means, because, on 
account of the violence of the symptoms, I did not 
conceive myself warranted to trust to the former 
means alone. 

A case of the same nature occurred to me, which 
afforded mean instructive lesson. A young wo- 
man complained that her menses had intermitted 
at the last period; she had found herself drowsy, 
sluggish, unwilling to move, and had a ser se of 
weight in the back and loins ; her bowels were kept 
pretty opt n, and she was ordered to walk about 
and force herself to be active. 

She continued to follow this plan, but her men- 
ses did not return. 

She was of a florid complexion, but slender make, 
and stooped a htile; a yelh wness began to appear 
about her eyes, the mouth, and on the forehead, 
and the drowsiness became worse. At this time she 
happened to be much terrified by something or 
other ; and in the same night the menses returned, 
and continued for the usual time, but were more 
copious, and her complaints eemed entirely remo- 
ved In a week or two, she was affected as before ; 
and when the time came at which the menses were 
expected, they did not appear. The drowsiness be- 
came worse ; poweriul cathartics did but relieve her 
for the moment ; indeed, she was affected with a 



233 

degree of stupor which seemed to demand immedi- 
ate relief. 

Accordingly, I took \6 ounces of blood from her 
arm ; she fainted, and was much indisposed all night, 
but next day she was greatly better, the menstrual 
discharge returned ; and she continued regular and 
in perfect health, and is so still, I believe. It is 
now several years since this occurrence took place. 

I bled her; but ought I to have concluded from 
this fact, that copious venesection is the only reme- 
dy for chlorosis ? 

Surely it would have been equally judicious, if, 
on account of occasional success, I had pronounced 
smart cathartics, wine and bark, and venesection, to f 
be, separately and indiscriminately, the proper re- 
medies for leucorrhoea. J •$ 

There can also, I may observe, be no question 
that amulets, charms, or whatever can inspire con- v 
fidence, will powerfully assist, and, in slighter cases, •**! 
perhaps, alone induce a cure **S^ 

Now, it will not be difficult for us to see, why 
the tonic remedies should maintain their character , 
in preference to others, since it is universally 
agreed, that this disease is, for the most part, one v^ 
of want of tone, not only in the uterus, &c. but in ^) 
the organs of digestion and nutrition : and that, by- 
promoting and invigorating the functions of the 
stomach and intestinal canal, we also restore that of 
the uterus ; these means, indeed, are always to be 
employed, before we have recourse to the more ac- 
tive, unless the urg< nc) of the case require the more 
prompt and efficarious measures. 

But because leucoirhcei resisted all these means, 
it has long bet-n classed among those irremediable 
evils which put fortitude 'to the test. 

Hoffman, who was among the first that clearly 
perceived the absurdit} of the humoral pa'tnolbgyJ 
with some justice, perhaps attnLuv . iu-ial 

inveterate obstinacy oi this disease to physicians 



234 

neglecting the atony of the uterus, the depraved di-. 
gestion, the general emaciation and debility ; from 
the belief that this affection originated in the vitia- 
ted fluids. 

Since his time, however, our pathological doc- 
trines seem to be better founded ; yet the practice 
in this complaint has not proved much more suc- 
cessful. 

I shall now detail the result of some part of my 
practice in this disease. 

CASE. 

A Lady of small stature, aged 25, mother of five 
children, who were all still born, or died immedi- 
ately after birth. 

Her general appearance indicated languor and 
debility, her eyes were peculiarly dull and heavy, 
her pulse feeble. 

I was informed that she had laboured under fluor 
albus for five years and a half, and the attack com- 
menced about two months before the birth of her 
first child. 

At that time, she informed the surgeon of the 
family of her complaint, who prescribed bark and 
wine, in the use of which she persevered, from the 
hopes of recovery, till disgust made her desist. Af- 
ter the delivery of her second child, she was advi- 
sed again to try again the bark and wine, which she 
continued to take till they produced nausea and vo- 
miting, and the very idea of them was loathsome to 
her. But no permanent alleviation of her disease 
had ever occurred during the use of these, or any 
other remedies which sapient mothers, or experi- 
enced old women, had persuaded her to take. Her 
complaint had gradually increased in violence, and 
was now almost intolerable. 

She said she understood that a complete cure 
was scarcely to be expected, but sh« would under- 



235 

go almost any degree of suffering to obtain allevia- 
tion. 

The pain of her back was excruciating, her ap- 
petite impaired ; and, so far from being able to 
walk, she could not even stand or sit, without the 
utmost uneasiness. 

The discharge per vaginam was so copious and 
incessant, that, though she used clothis, &c. she 
was always afraid of being in company, lest the floor 
should show her condition. In addition to all 
which, she was frequently attacked by paroxysms of 
hysteria. 

The discharge was of a glairy appearance and 
consistence. 

During the whole time of the disease, the men- 
struation had been regular and natural ; and what 
is worthy of remark, the tluor albus was more vio- 
lent during pregnancy than at other times. 

The patient said, (hat the flow was not in uniform 
quantity ; and that an unusually great discharge was 
always preceded by an excruciating pain in the situ- 
ation of the kidneys, on which occasion t-he always 
had the distinct sensation of something flowing, as 
it were, downward from the loins, and the cloths 
applied were found wet with the discharge. 

I prescribed the tincture of cantharides, which she 
continued to use, with the occasional use of an in- 
jection, for nearly three months During this pe- 
riod, her complaint underwent various changes, be- 
ing sometimes even much worse than before the use 
of the cantharides ; bat becoming pregnant, and her 
complaint being nearly removed, I desired her to 
discontinue its use. 

This pregnancy was attended with circumstances 
very different from those of any former one, shew- 
ing, that some remarkable melioration had been ope- 
rated in her constitution. 

In her former pregnancies, the leucorrhceal dis- 
charge was exceedingly abundant ; in the present, 



23(5 

after the two first months, the discharge resumed 
the glairy appearance, but was never very copious. 
In the former, she was much afflicted with uneasiness 
in her back and loins, and a very distressing sense 
of langour and weakness of the whole body ; in the 
present, she was lively and active, having no other 
cause of complaint than what was common to her 
with other women in her situation ; in short, the mo- 
tions of the child were more distinctly perceived by 
her, and her health infinitely better. 

She was delivered by Dr Hamilton, Professor of 
Midwifery, of a stout and healthy female child ; her 
former children were still born, or died soon after 
birth. Her labour was of short duration, and much 
more painful than formerly. 

Her milk generally resembled thick pus, now it is 
qmtt natural Her cleansings were very copious, and 
resembled tar ; now they are as is usual to women 
after delivery. Pains in her back, and feebleness, 
distressed her severely, long after her former deli- 
veries ; but at present, she is exempt from these, and 
she and her child are doing/extremely) well. Since 
this, she has had two other stout children, which 
are both alive, and well, and the lady herself enjoys 
the most perfect health. 

CASE. 

An unmarried Lady, aged 20, of delicate habit, 
pale, feeble, and emaciated, complains of all the 
symptoms of a far advanced leucorrhcea, of nearly 
four years continuance. 

The menstruation observes the regular period, but 
is usually copious and distressing ; and, at this time 
in particular, she is subject to attacks of hysteria. 

Influenced by that delicacy peculiar to her sex, 
she long concealed her situation from any medi- 
cal man ; but at length she was prevailed on to al- 
low a statement of her case to be submitted to the 



237 

judgment of a near relation of her own, practising 
medicine in London. He ordered the loins to be 
bathed trvery morning with cold water, holding salt 
in solution. This practice for sometime seemed be- 
neficial ; but, on its being intermitted or neglected 
in the least, the malady always recurred, with much 
aggravation ; on which account she ceased to em- 
ploy it ; and the disease having imperceptibly under- 
mined her constitution, there wasconsiderable appre- 
hension for her safety. She at last consented to adopt 
any plan of medical treatment that might be pro- 
posed, as the means of recovery. 

In this case, Dr Gregory, Professor of the Practice 
of Physic in this University, was consulted, who 
deemed this a fair opportunity to try the power of 
the cantharides, which, I had informed him, I found 
to be a very effectual remedy in similar instances. 

For this patient I therefore also prescribed tinc- 
ture of cantharides. This she continued to use at 
least two months, when her complaint entirely dis- 
appeared, 

Although she was some months after affected 
with other debilitating complaints, the leucorrhoea 
did not return. 

CASE 

A Married Lady, aged 35, a very tall and slender 
woman, was affected with this di&ease : She appear- 
ed extremely debilitated, or rather almost exhausted, 
had had four living children, and two abortions. 

She had a very favourable recovery after the birth 
of her second child, and at that time the leucorrhoea 
commenced. 

Her first child died at 15 months old, two ab- 
ortions followed the birth of her second, and after 
this, she had two children, each at the lull time, but 
they were both very sickly and delicate. She had 



23S 

not been pregnant for two years immediately pre- 
ceding-. 

The discharge per vaginam was glairy, in great 
quantity, and almost incessant. 

Her menses observed the regular periods, but were 
of extraordinary quantity, and attended with excru- 
ciating pains, which generally commenced a few 
hours before the flow. 

Agitation of mind increased the leucorrhceal dis- 
charge, and it was always much worse during preg- 
nancy. 

Her urine passed with difficulty, was tinged of a 
brown colour, and sometimes contained a matter of 
the appearance and consistence of the leucorrhceal. 

She used nothing but a little Holland's, diluted 
with water, which she was persuaded to do by her 
midwife, who informed her that her complaint was 
a gravel. 

I prescribed the tincture of cantharides, and in a 
fortnight the discharge ceased. She had, for two 
or three weeks afterwards, when exposed to fatigue, 
a slight return of the discharge, but on removing the 
cause, it soon disappeared, In the beginning of the 
following year, about a year after she begun the use 
of the cantharides, she bore a fine healthy child, and 
remained quite free from her complaint. 

CASE. 

A Lady, aged 28, uncommonly tall, and of slender 
habit, had been married nine years, before which she 
had a slight attack of leucorrhcea, but soon after- 
wards she became pregnant, and it disappeared. 

The child was born at the full period, and lived 
only four months. On the loss of the infant, the 
mother was seized with violent hysteria, which was 
immediately followed by a renewal of the leucorrhcea. 
Ever since that time the flow had continued, almost 



239 

imperceptibly augmenting, and she has been fre- 
quently subject to very violent attacks of hysteria; 
but, about four weeks ago, the quantity of the dis- 
charge was of a sudden greatly increased, accom- 
panied with exquisite torture in the situation of the 
kidneys. 

Her menstruation was of regular occurrence, but 
for some months preceding very scanty. She seem- 
ed very much enfeebled and emaciated ; and was so 
weak in the joints of the lower extremities, that she 
was often unable to stand. 

Her surgeon and midwife informed h«r, that a 
permanent cure was not to be expected. 

Bathing the parts twice a day, for some years, had 
never even mitigated the complaint. 

When I was called to this patient, she concealed 
her real disease, but wished some external means to 
be used to remove an excessively severe pain in the 
lumbar region. 

Alvine, and other discharges, she affirmed, to be 
regular and natural. 

I learned, however, from a female domestic, what 
afflicted our patient ; and by telling her of her dan- 
ger, and that there might still be means found to 
restore her failing constitution, she informed me of 
the circumstances above related ; but added, that 
she could not understand what connection there 
could be between that complaint and the dreadful 
pain in her back. After assuring her, that these 
pains were very common under such circumstances, 
I prescribed the tincture of cantharides for her, 
which she continued to use about a month, when 
her complaint had entirely disappeared. 

This lady had, tor two or three months, slight re- 
turns of the discharge, but they entirely disappear- 
ed, by the use of a small quantity of the cantharides, 
accompanied by the use of the cold bath. 



240 



Cases of Leucorrhcea, attended by or causing other 
Diseases. 

CASE. 

A Lady, aged 2Q, of a very delicate form, had 
been married 1'2 years, and had had two children; 
but six years ago, a few weeks after the birth of the 
youngest, she was affected, for the first time, with 
leucorrhcea, which, being uncommonly prof use, trou- 
bled her very much. If her mind was in any way 
agitated, which very frequently happened, her com- 
plaint was always aggravated in a great degree for 
several days. For the last three years, she had suf- 
fered much from weakness in her loins, and from 
severe pains in the situation of the uterus,-<and the 
discharge had been of a thick yellow consistence. 
Bearing down pains, too, as they are called, were often 
indescribably irksome to her, and from time to time, 
darting pains in these parts troubled her. She had 
likewise been for about three years affected with an 
eruption on different parts of her face, which was 
the complaint I was first consulted about, when, 
two months ago, I was desired to visit her. She did 
not inform me, of her being affected with leucor- 
rhcea; I therefore prescribed a solution of the muriate 
of mercury in alcohol, to wash the affected parts with 
twice a day, which removed the irruption ; it how- 
ever soon recurred, and the same application was 
again had recourse to, with the same beneficial effect. 
On the 1st December 1807, I was informed of her 
being affected with leucorrhcea, and of the other 
symptoms connected with it, above described. I 
prescribed for her, tincture of cantharides half an 
ounce, water six ounces : a table spoonful to be taken 
four times a day. She continued the use of this me- 
dicine, according to the above direction, fully a fort- 



night, before she was sensible of an effect being pro. 
duced on her urinary organs. She was likewise de- 
sired to employ cold lavation. A small augmentation 
of the dose of the cantharides occasioned a good 
deal of pain during the night, while in bed, but this 
abated before morning. 

On the 18th, she had continued the use of this 
medicine in sufficient doses to produce some degree 
of pain in voiding urine, and the pain was often con- 
siderable, particularly toward evening, which she 
partly ascribed to her want of caution in the use of 
the medicine, She thinks the discharge is less in 
quantity than formerly, and she is much less distress- 
ed with the bearing down and shooting pain across 
the loins. I have therefore desired the cantharides to 
be continued. 

On the 24th, from incautious exposure to cold, 
she had for two days suffered a good deal from pains 
in different parts of the body, somewhat similar to a 
slight rheumatic affection, and she thinks the dis- 
charge is rather augmented in quantity. I ordered 
the cantharides still to be continued, but desired her 
to omit the cold lavation for a few days. 

On the 26th, acute pain in the situation of the 
kidneys had troubled her since yesterday ; the pain 
also in voiding urine had been troublesome, but the 
discharge was undiminished in quantity. I therefore 
ordered the cantharides to be continued. 

On the 2d of January J 808, the eruption on her 
face, formerly described, had considerably abated, but 
the leucorrhoeal discharge was undiminished. Pains' 
in her back were very troublesome. I have ordered 
the cantharides to be continued, and as the pains 
formerly mentioned had left her, I desired her to re- 
commence the cold lavation. 

On the 4th, she had suffered a considerable deal 
of uneasiness from the cantharides during the two 
last days, particularly toward evening. She had like- 
wise constantly felt a prickly sensation in her fingers/ 
9 



242 

and a soreness in her face, and the pain also in the 
situation of the kidneys had been very troublesome. 
I ordered the cantharides to be continued only in 
small doses. 

On the K)th, the discharge had greatly diminish- 
ed since last report, and, instead of that peevishness 
which once was so irksome to herself, and distress- 
ing to others, she feels contented and happy, com- 
paratively speaking, to what she had been for many 
years. I therefore ordered the cantharides to be 
continued 

On the 17th, the discharge was small in quantity ; 
it however constituted the only symptoms of her 
complaint ; all her other distressing feelings having 
undergone a complete revolution for the better. 
The eruption on her face was now gone, and her ap- 
pearance bespeaks a greater degree of health than 
she confesses she ever expected to enjoy. I desired 
the cantharides to be continued. 

On the 20th, she suffered violent agitation of 
mind, in consequence of which she was very sick on 
the following morning. I, however, desired the can- 
tharides to be continued. 

On the 22d, the discharge returned with very great 
violence, and the same kind of pain, which she ori- 
ginally felt in her back, likewise returned. I desired 
the cantharides to be continued. 

On the 1st of February, a succession of unpleasant 
circumstances had agitated her mind since last re- 
port ; the discharge was now worse than ever, and 
all her original complaints had returned in a violent 
degree. I ordered the cantharides therefore to be 
continued, and cold lavation to be used. 

On the 3d, her complaints were again beginning 
to abate, yet her state of mind was by no means fa- 
. vourable for their removal. I desired the cantha- 
rides, &c. still to be continued, and three or four 
glasses of wine to be taken daily. 



243 J 

On the Sth, all her complaints had again abated, 
except the discharge, and the eruption on her face 
was almost completely gone. The cantharides, how- 
ever, were continued. 

On the 10th, from unavoidable circumstances, her 
mind was still very much distressed, and she invari- 
ably observed, immediately after such an occurrence, 
that she had a regular recurrence of the discharge. 
The cantharides were continued. 

On the 20th, no alteration had appeared in the 
discharge since last report ; but the pain in her back 
had greatly abated. The cantharides were still con- 
tinued. 

On the Jst of March, the discharge continued as 
above described. Three days preceding this, she 
had struck her ankle against a table, and bruised it 
considerably, and in one part abraded the skin. The 
iuflammation of the wounded part had become vio- 
lent, and I ordered it to be poulticed. 

On the 4th, inflammation and pain of the leg had 
still continued to increase ; I therefore desired her to 
omit the cantharides for a few days. 

On the 10th, the sore was nearly well, but since 
she left off taking the cantharides, the leucorrhoea 
had been worse. The cantharides, however, were 
still discontinued, and the sore dressed with simple 
ointment. 

As, after this date, no material alteration in the 
daily reports of the case occurred, I deem it unne- 
cessary to insert them. I may only mention, that 
this patient continued the use of the cantharides till 
the 1st of June, when the discharge had completely 
abated for more than two weeks. She was now, in 
every respect, in a better state of health than she had 
been for several years, and the eruption on her face 
had disappeared. I desired her to continue the can- 
tharides in small dozes for a few days, and to use the 
cold sea bathing. 

This lady has since had a stout healthy child, 
o 2 



244 



CASE. 



A married Lady, aged 32, eleven years ago, bore 
a female child, and soon afterward was affected with y 
very profuse leucorrhoea. She had had no children A*M 
since. She suckled the child for ten months, during 
which time she never recovered her former strength. 
The first appearance of her menstruation after hav- 
/ #-\ ing nursed the child, was of much smaller quantity 
than formerly, yet still it observed the regular peri- 
ods. She had been informed by some sage matrons, 
that the discharge of leucorrhoea was natural to her, 
and that every woman had it less or more : They 
even adduced arguments in proof of its being neces- 
sary to the preservation of her health, and that she 
ran the greatest risk of her life if she attempted to 
stop it ! Thus influenced, she never attached to its 
existence any consideration of importance, but attri- 
buted the pains in her back, which she began to be 
troubled with, particularly about three years after 
the commencement of the disease, to other causes 
than this. She was now affected with general lassi- 
tude, accompanied by hysteria, and was advised by 
her former medical attendant to go to sea-bathing 
quarters, which improved her general health very 
considerably ; but she experienced no good effect 
from it in the removal of the leucorrhoea. Finding 
this the only remedy from which she derived any be- 
nefit, she had recourse to it regularly every season, 
but still the leucorrhoea continued in greater quanti- 
ty, and she at length became gradually more debili- 
tated, notwithstanding the sea-bathing. About five 
years ago, her menstruation recurred every three 
weeks, and in very small quantity at a time, and 
she was continually troubled with a distressing weak- 
ness in her loins From time to time, too, she felt 
pains darting down her thighs, and soon after this an 
eruption of purplish coloured pimples, unattended 



245 

by any pain, broke out on the under part of her 
face, which resisted the effects of a variety of sub- 
stances given for their removal. She was now advis- 
ed by the surgeon who attended, to use bark and 
wine, which she did rn great quantities, and he, at 
the same time, prescribed an injection for the re- 
moval of the leucorrhoea ; but although at first the 
use of the bark gave her a better appetite, neither 
this nor the injection had any effect in removing the 
leucorrhoea. She soon became disgusted with the 
bark and wine, yet she persisted in its use, being re- 
peatedly assured that it would remove her complaint; 
nausea and vomiting, however, at length followed 
every dose of it, and she laid it entirely aside. The 
leucorrhoea still became more troublesome, so that she 
was constantly obliged to wear cloths, and she at 
length endeavoured to reconcile herself to her hard 
fate. She was sometime ago advised to put an issue 
in her arm, for the removal of the eruption on her 
face, which had assumed a very unpleasant appear- 
ance ; and, eager to embrace every chance of alle- 
viating her complaints, she placed great dependence 
on this application. When I was consulted about 
this patient, she gave me the above history of her 
disease, with the means which had been unsuccessfully 
prescribed for its removal. I conceived, from having 
met with similar instances, that the smallness of the 
quantity, and the frequent recurrence, of her men- 
struation, as well as the eruption on her face, de- 
pended, perhaps entirely, on the leucorrhoea, or rather 
on the state of body which occasioned it, and that 
the issue in her arm could have no good effect. I 
therefore ordered her to heal it, and prescribed for 
her, on the 16th of November, tincture of canthari- 
des half an ounce, water six ounces : A table spoon- 
ful to be taken four times a-day. She took one 
spoonful at mid-day, and before the evening, when 
she intended to take the second dose, she was affec- 

0-3 



246 

ted with great pain in passing water ; evidently in 
consequence of her having taken a single dose of the 
medicine. She however, took the second, and suf- 
fered considerable pain during the night. These 
sensations abated in the morning, and she had taken 
the doses regularly during this day, the 17th, with- 
out any return of the pain till the 2 1 st. Although 
she had regularly taken 313J. of the tincture each day, 
she had not, except almost immediately after the 
first dose, experienced any pain, when she felt slight 
uneasiness with a more frequent inclination than 
usual to void urine. She thought the quantity of the 
discharge had abated considerably, and she expected 
her menstruation to appear four days before, but it did 
not. She however experienced no inconvenience in 
consequence of this, and I desired the cantharides to 
be continued. 

On the 23d, slight cough, with pain in the head, 
had troubled her for two days, and I desired her to 
take a small tea-cup full of an infusion of camomile 
flowers thrice a-day. For the alleviation of the cough 
I likewise desired her to inhale the steams of vinegar 
and warm water, morning and evening, and to con- 
tinue the cantharides. 

On the 25th, the above symptoms had disappear- 
ed, and her menstruation came on this evening im- 
mediately after she had been taking an airing a few 
miles in a carriage. The cautharides, &c. were 
continued. 

On the 28th, menstruation had ceased, and she 
found the discharge somewhat abated. The can- 
tharides were still continued. 

On the 1st of January, J 808, she had, since last 
report, experienced a good deal of pain from the use 
of the cantharides, but this had never been so severe 
as on the first day, after taking only one dose of that 
medicine. She frequently experienced pains in her 
head with general debility, which proved very trouble- 
some for a few hours. She had, in such states, ob- 



247 

tained partial reVef from the use of purgatives, and 
once or twice, when these failed, she derived great 
benefit from the use of a strong tincture of gentian 
root, these symptoms evidently having their origin 
in the stomach. The eruption on her face was now 
much less than formerly, which gave her great hope 
of recovery, as always, on former occasions, it became 
greatly worse for nearly a fortnight after her mens- 
trual period. She now took 3 drachms of the tinc- 
ture of cantharides each day ; which produced very 
little uneasiness, and I have desired that medicine 
to be continued. 

On the 7th, the discharge was becoming evidently 
less in quantity ; but she complained of great weak- 
ness, and very little exertion fatigued her She 
could now t:ke the cantharides nly in small doses, 
owing to its effects on the urinary organs, and her 
urine was very high-coloured, when she was affected 
in that way by the cantharides. 

On the gtb, she took rather too large a dose of the 
cantharides, which kept her very uneasy for several 
hours. 

On the 11th, a great deal of membraneous sub- 
stances had come off since the preceding day, re- 
sembling a quantity of chaff floating in her urine. 
I desired the cantharides to be continued in smaller 
doses. 

On the iQth, the discharge had abated gradually 
since last report, and she now felt greater inclination 
to walk abroad, than she had done since a short time 
after the commencement of her complaint. The 
cantharides were therefore to be continued in rather 
larger doses. 

On the 20th, she was suddenly- alarmed by an 
unexpected occurrence, and her complaint, almost 
instantly, became much worse. She now began to 
despair of getting well, and it was with some diffi- 
culty I could prevail on her to continue the canthari- 
des. She however at length consented. 

CL4 



24B 

On the 2<3, since last report the discharge had 
gradually abated, and she was nearly in the same 
condition as before the 20th. Menstruation commen- 
ced this day I desired the cantharides to be continued. 

On the 2d of February, the discharge had almost 
entirely disappeared. She had taken too large dose? 
of the cantharides three or four times this day, and 
toward evening she felt severe pain in passing urine. 
I desired her to discontinue the cantharides. 

On the 6<:h, the pain had abated, and the discharge 
was scarcely perceptible. I however desired her to 
take the cantharides, but in very small doses, and 
likewise three or four glasses of wine in the course of 
the day* 

On the 8th, the discharge had entirely disap- 
peared, and the eruption on her face was much bet- 
ter, but it had not entirely disappeared. The can- 
tharides were still continued in small doses. 

On the 16th, the discharge had recurred in consi- 
derable quantity* attended by pain in the lumbar 
region. She could not account for this ; but by ano- 
ther member of the family, I was informed that her 
mind had been considerably agitated for two or three 
days before. This agitation of mind has uniformly 
had the effect of bringing back the discharge in al- 
most every case of leucorrhcea that I have met with, 
particularly in ladies who are easily affected in this 
Way. The cantharides were continued. 

On the 18th, the discharge was scarcely percepti- 
ble The cantharides however were continued. 

On the 24th, menstruation commenced, and she 
thought that the eruption on her face was worse than 
it had been for several months. As the discharge 
had not entirely abated, 1 desired the cantharides to 
be continued 

On the 10th of March, the discharge had lately 
varied in quantity, but it had never been nearly so 
bad as it was originally. I desired the cantharides 
to be continued. 



240 

In the beginning of April, the discharge had gra- 
dually abated, and was now entirely gone. Cold 
Sea-bathing, small doses of cantharides, nourishing 
diet and gentle exercise, were desired to be used for 
a few weeks 

On the 6th of June, there had been no return of 
her complaints, and the eruption on her face had 
disappeared along with the leucorrhcea, except one 
single pimple, which I have no doubt will be entirely 
removed before the sea-bathing season has elapsed. 

October ibOy. This lady continued free from all 
her complaints. 

CASE. 

Mrs , aged 35, a little delicate woman, and 

mother of two children, being poor, was at each 
birth obliged to endure many inconveniences while 
in child-bed ; and when last in that situation, nine 
years ago, she was, almost immediately after delive- 
ry, actually obliged to employ herself at some kind 
of work for the support of her family. While mak- 
ing a sudden exertion, she felt something about her 
loins give a sort of crack, but she was not sensible 
of any great inconvenience from it, except that the 
lochial discharge, which was before moderate, now 
increased in an alarming degree. This terminated 
in an almost constant and profuse flooding, which 
for several months after continued to distress her. 
During its continuance, she was bled and purged 
most unmercifully, but without deriving any benefit 
from them ; on the contrary, she was sensible of the 
daily diminution of her strength. About two years 
afterwards the flooding became less violent, though 
•still very troublesome ; and about three years ago, 
she observed, in the intervals between its appearance, 
that there was a constant glairy discharge, in consi- 
derable quantity, and this, with the flooding, attend- 



250 

ed by excessive pain, which, from time to time still 
continued, and had reduced her very much. 

For eighteen months past, the leucorrhcea had 
been excessive, pains in her back had likewise been 
very troublesome ; cough, and pains in the breast, 
with great general debility added to these, had in- 
deed rendered her existence a burden to her. There 
was, too. a parched dryness all over her skin, of which 
she complained very much 

I prescribed tincture of cantharides for this pa- 
tient, 30 drops to be taken in a little water thrice a 
day. 

For two months she continued to follow the a- 
bove direction, and the leucorrhcea and flooding 
had completely disappeared. She had no pain in 
her loins ; the parched state of her skin, with the 
cough, had left her, and she was in every respect 
perfectly recovered. 

Four months afterwards she continued free from 
pain, and was in much better health than she had 
been at any time since the commencement of the 
above described complaints. 

CASE. 

A Young Lady, aged 13, had, from her birth, 
been affected with leucorrhcea and incontinence of 
urine. The leucorrhoeal discharge had, especially of 
late, been constant, in immense quantity, and con- 
sequently excessively troublesome. The inconti- 
nence of urine was most troublesome during the 
night while in bed ; and although, previous to its 
approach, she was sensible that it was about to 
trouble her, she was still unable to prevent it. This 
lady' was of a delicate form, but not so much ema- 
ciated as, from the continuance of such complaints, 
might have been expected 

As she had been habitually costive, I prescribed, 
on the 24th of September, pills composed of equal 



251 

parts of extract of hyociamus and aloes ; and, on the 
following day, I prescribed the tincture of cantha- 
rides. 

On the 2d of October she, for the first time, suf- 
fered slight pain in voiding urine. The leucor- 
rhoeal discharge seemed rather less in quantity, but 
the incontinence of urine was unaltered. 

On the 7th, the leucorrhceal discharge had stopt, 
and, for 24 hours previous, she had had no invo- 
luntary discharge of urine. 

On the 10th, the leucorrhoeal discharge and in* 
continence of urine, had both returned, and were 
as bad as before the exhibition of the cantharides. 
I therefore desired that this medicine should be 
continued. 

On the 13th the leucorrhoeal discharge had again 
subsided, and the incontinence of urine had consi- 
derably abated 

From the evening of the 14th, till the morning 
of the 17th, she had no incontinence of urine, but 
then it became as profuse as ever. 

On the 19th she complained of uneasiness in her 
stomach, and loss of appetite. I therefore desired 
that the cantharides should be omitted, and that 
rich soups and wine should be taken freely, and cold 
sea-bathing be used. 

On the 21st the leucorrhoeal discharge and in- 
continence of urine had recurred in a slight de- 
gree ; she then thought herself even worse than be- 
fore the administration of cantharides, which, the 
complaints in her stomach having abated, was now 
recommenced as formerly. 

On the 24th the leucorrhcea was entirely gone, 
and the incontinence of urine had greatly abated. 
I ordered the cantharides still to be continued, cold 
bathing to be used, and moderate exercise in a car- 
riage to be taken. 

On the 26th, on getting out of bed, the leucor- 
rhoeal discharge returned in considerable quantity. 



252 

This she attributed to the effect of a cathartic which 
she took the preceding night. The discharge was 
always increased when she took such medicines. 
There occurred, however, no incontinence of urine. 
I have desired the cantharides still to be continued. 
On the 28th, very early in the morning, she suf- 
fered much from pain, from having used the can- 
tharides rather liberally during the whole of the 
preceding day, and there was a slight discharge, 
but no incontinence of urine. I however desired 
that the cantharides should still be continued in 
small doses, with wine, exercise in a carriage, and, 
independently of the advanced state of the season, 
cold bathing. 

On the *2Qth, although no discharge nor inconti- 
nence of urine had recurred, yet I ordered the can- 
tharides still to be continued. 

On the 31st the discharge, immediately on get- 
ting out of bed, was in alarming quantity, but there 
was no incontinence of urine, nor had she any dis- 
charge during the day. I desired the cantharides 
still to be continued. 

On the 1 1 th of November, she first, since last re- 
port, perceived a slight discharge on getting out of 
bed, but there was none during the day. I still de- 
sired the use of the cantharides to be persevered in. 
On the 13th, she suffered considerable pain from 
having taken the cantharides rather freely. There 
was, however, no discharge nor incontinence of 
urine, and I desired that the cantharides should be 
continued. 

Till the l6th, she every morning had a consider- 
able quantity of leucorrhoeal discharge. This some- 
times began even before she got out of bed, but 
continued only about half an hour after she arose. 
Still, however, her general health was much im- 
proved. Owing to the inclemency of the weather, 
I now desired her to omit the bathing, but ordered 
the cantharides, &c. to be continued. 



253 

Till the 26th the leucorrhceal discharge had con- 
tinued about half an hour every morning till now* 
when there was none. 

On the 6th of December, there had been no dis- 
charge since last report. I however desired that 
the cantharides, &c. should still be continued. 

Till the 20th the discharge had occasionally been 
troublesome, but now it was scarcely perceptible. 
I still, however, desired the cantharides to be con- 
tinued. 

On the 28th the discharge had again become 
greater in quantity, but, independently of this, her 
general health was Very good, and, within these few 
months, she had become much taller and stouter 
than usual. I ordered the cantharides still to be 
continued. 

On the 13th of January following, the discharge 
had continued to vary in quantity, but even at its 
worst it was trifling, compared to what it had been 
before the use of the cantharides. Anxious to re- 
cover rapidly, she had lately taken larger doses than 
usual of the medicine, from which she suffered 
considerable pain ; but this, soon abated, and I 
desired the cantharides to be continued in modera- 
tion. 

On the 8th of February she had for some days 
past been very easily affected by the medicine, so 
that very small doses of it occasioned considerable 
pain in voiding urine. 

On the 1st of March her complaints had greatly 
abated, as scarcely any discharge was perceptible. 
She had recommenced the cold sea-bathing four 
times a week, along with the use of the cantharides 
in small doses. 

In August following, she had entirely recovered 
from both these unpleasant complaints, and had be- 
come remarkably stout. She had taken no cantha- 
rides for about two months, and I did not desire 
her to recommence it. 



254 



u~? 



CASE. 

Mrs aged 30, of a delicate habit of body, 

was married several months before her menstrua- 
tion, and about two months after it commenced, 
she became pregnant. During the fourth month 
of gestation, she had an abortion, followed by a 
considerable flooding, which, though severe while 
it lasted, abated in a few months without the use 
of medicines. Five years afterwards, she again be- 
came pregnant, and bore a healthy stout child at 
the full time. She observed, for several months, 
that two or three days before and after menstrua- 
tion, she had a thin glairy discharge ; but in the in- 
terval, this did not trouble her in the slightest de- 
gree. 

About the beginning of the year 1 607, she again 
became pregnant ; in the fourth month, during the 
frost, she fell down stairs, which was immediately 
followed by violent flooding, and in a few days af- 
ter, by an abortion. The midwife who attended her, 
used much violence in bringing off the placenta, to 
which my patient attributed the excessive flooding 
that for nearly three months afterwards distressed 
her. Abstinence from every stimulating substance 
was, by her medical attendant, strictly enjoined, 
because they would irritate the parts, and increase 
her complaints ; but affussion of cold water was 
plentifully applied. From this treatment she de- 
rived no benefit, and at length desisted from this ap- 
plication. The flooding spontaneously left her a 
lnoutn ago ; and for a few days about that time, 
she had a very great leucorrheeal discharge. Her 
complaint was now thought to be consumption of 
the lungs, and treated as such till the 26th of De- 
cember, when I saw her for the first time. 



255 

For nearly four months past, she had lost, almost 
completely, power over her right arm ; pains in 
every part of her body, but particularly in her back, 
had been most excruciating, and for several years 
she had been affected with hysteria to an indescrib- 
able extent. Her bowels were very costive. 

As she did not appear to me to have consump- 
tion, I conceived, from the symptoms of her com- 
plaint, that this state of extreme debility was inti- 
mately connected with the diseased action of the 
generative organs, and I immediately altered the 
mode of treatment. I ordered her half a pint of 
wine a day, and desired her to take such soups as 
the weak state of her stomach would admit. I like- 
wise prescribed the tincture of cantharides, and an 
aloetic pill, to be taken occasionally. 

By the end of March following, this patient had 
completely recovered from all the above distressing 
complaints. 



General Remarks on the Treatment of Chlorosis, 
Dysmenorrhea and Menorrhagia. 

The removal of those diseases of the female or- 
gans of generation, as restoring the general health 
of the patient, is of great importance ; but what, in 
common with the disease of the preceding section, 
renders their cure incalculably important, is the 
restoration of the lost functions of those parts by 
which our species are propagated. 

The treatment of these complaints has been va- 
rious, regulated rather by accident, or the whim of 
the moment, than by the success attending it, or 
by any fair mode of reasoning by the physician. 
In consequence, therefore, of this complete want 



256 

of success, these complaints have been considered 
as incurable, unless, which was only likely to hap- 
pen in very slight cases, some favourable change 
accidentally took place in the constitution of the 
patient ; and indeed this was all that either the 
physician or the patient looked to for relief. Phy- 
sicians, therefore, considering these diseases as in- 
curable, instead of devoting their time to discover 
some successful mode of treament, employ them- 
selves in amusing their patients, by assuring them, 
that the various natural changes which, at certain 
periods of their lives, must take place in their sys- 
tem, will probably effect a removal of their com- 
plaints. Thus, in anxious expectation of such 
changes taking place, the patient's vigour of consti- 
tution is gradually yet surely wasted ; and too often, 
without the arrival of the long and anxiously wish- 
ed for relief other diseases, consequences of the first, 
attack them, which, for the most part, only termi- 
nate with their miserable existence. 

If one or more of these complaints be brought on 
by long continued, though slight leucorrhoea, our 
attention being principally paid to this last, and a 
complete removal of it effected, almost all the other 
affections will with it completely disappear. 

Whatever may have originally caused chlorosis, 
dysmenorrhaea, menorrhagia, or leucorrhoea, and al- 
though probably the uierine vessels are, during 
such states, principally affected, yet we uniformly 
observe, with scarcely an exception, that general 
stimulants, applied for a length of time, remove all 
of them. 

By considering these complaints of the female as 
totally different from each other, and recommend- 
ing entirely a different mode of treatment for each, 
we not only fail in that success which is wished for, 
but we render the natural simplicity of su<_h com- 
plaints extremely perplexing. 



257 

f\ As menstruation depends on the general state of 
the system, all its derangements are to be consi- 
dered as resulting from derangements of the sys- 
tem in general, and that, therefore, in the medical 
treatment applicable to them, general applications 
are to be adopted, and topical ones, at present al- 
most entirely resorted to, to be avoided. General 
remedies are indeed sometimes resorted to, but they 
are, in my opinion, altogether inapplicable. If it 
arises from debility, the cold bath with general sti- 
mulants are to be had recourse to ; if from plethora, 
friction, depleting medicines, blistering, and abstrac- 
tion of blood, in such quantities as may be best suit- 
ed to the strength of the patient, must be preferred. 



Athough Dr Cullen's mode of considering amenor- 
rhoea or chlorosis, seems very judicious, yet, in his 
practice, there is a great falling off; for the reme- 
dies he recommends, in suppression of menses, are 
either totally incapable of permanently removing ge- 
neral or local debility, or calculated, in a great mea- 
sure, to encrease that very debility which he wishes 
to remove, such as purging, mercury, &c. 

He forbids tonics and cold bathing, as they appear 
to him of ambiguous effect. 



jr. 



The common practice of employing opiates and 
hyociamus, together or separately in dysmenorrhoea,- 
may give temporary relief, but we cannot depend on 
them for an entire removal of the disease, except in the 
very slightest cases, or when it is principally of a local 
nature. From our disappointments in effecting a com- 
plete cure, by these substances, we have long been 
convinced of their inutility. For although temporary 
relief is obtained by their use, the same diseased state 

R 




258 

of the parts still continuing, the return of the next men - 
N strual period brings with it all the former symptoms 
perhaps in an aggravated degree, and the harassed and 
enfeebled patient, by the supervention of dropsy, con- 

> I M ""^Sumption, or some other equally fatal disease, at length 

x -y j sinks under her accumulated sufferings. Practising 

» \ 4 with the remedies recommended by Dr Cullen, or in- 

%} k> deed with any remedies, if they be suited to his general 

mode of reasoning in this complaint, will, I venture to 

Q \) J assert, be unsuccessful, in every well marked case. 
When the disease has in a great degree deranged the 
general health, Dr Cullen seems to think it incurable. 
The only remedies he then recommends, are exter- 

Vj^ nal or internal astringents, cold bathing, and chaly- 
beates, which, and similar applications, I have re- 
peatedly prescribed, and that to the greatest extent, 
in such cases, without deriving any thing more than 
temporary relief from them. Permanent advantage 
cannot be expected from them. 






; Although, during the early stages of menorrha- 



ric persons, when the pulse is unabated in strength, 
and when no apparent debility has been induced ; 
in short, when all the other functions of the body 
seem unimpaired, and even when bloodletting is 






indicated by the apparent fullness and inflammatory 
.'action of the system, the greatest caution, even at 
this period, ought to be observed in adopting blood- 
letting for its removal. Even the exhibition of me- 
dicines that may ultimately induce debility, ought 
c to be resorted to with nearly equal caution. For 
i even although these means may, in almost every 
case, remove the morbid discharge, T have often 
observed, that after such treatment, it was long be- 
fore the patient recovered her usual strength, and 
she remained often for years subject to returns of 



15Q 

the menorrhagia, from the very slightest causes. 
But when such practice has been adopted, in weak- 
ly and debilitated habits, (for it is too often indis- 
criminately applied) the system is not only left in a 
dreadfully debilitated state, liable to almost conti- 
nual flooding, but the most obstinate and trou- 
blesome cases of leucorrhcea that I have ever met 
with, have been brought on after the application of 
such means. The remedies, then, which Cullen re- 
commends, are either hurtful, inactive, or of a trif- 
ling nature, and, upon the whole, by no means suit- 
ed to the removal of such complaints. He forbids 
the use of all medicines that may irritate the parts. 
I think, however, what I have to state will com- 
pletely prove that such remedies only, as Cullen 
thinks would irritate the uterus, are calculated per- 
manently to remove such diseases ; and that the 
chalybeates, &c. if deemed necessary along with 
such medicines, may be useful, but never can, ex- 
cept in the very slightest cases, effect a perfect cure. 
If, during these complaints, which does not of- 
ten happen, the pulse indicates inflammatory action, 
and the patient happens to be of a full plethoric ha- 
bit, should cantharides be prescribed, I grant that 
it would require no difficult calculation to foretel 
what would be the result. Benefit must, under 
these circumstances, be evidently sought for from 
very different treatment. 



In all these complaints, then, I believe the only 
medicines that can be employed with decided ad- 
vantage, are those of a stimulating nature. Food 
and drink, as well as medicines, ought all to be 
considered in this way. In those affections, the 
uterine vessels are in a state of great disease ; but 
it appears to me, that the general habit of body has 
been, and is equally deranged. The medicines, 
B2 



260 

therefore, to be employed, are such as will suffi- 
ciently affect the whole system, and the generative 
organs as a part of the whole. 



The cases which I have lately seen, of what fe- 
male patients call lumbago, are too numerous to be 
particularised ; many of them entirely depending on 
a diseased action of the generative organs, and can 
only be relieved by the removal of such disease. 
Although I have long been aware that pains, in ma- 
ny respects similar in their nature to lumbago, are 
very common in far advanced and very bad cases of 
leucorrhcea, for instance ; yet, till lately, I never 
have met with cases of leucorrhcea, where the dis- 
charge had always been of small quantity, indeed, 
in some cases, scarcely perceptible, and in these the 
most acute pains in the loins accompanied it. 

Lumbago, then, so common in these diseases, 
has been improperly treated as a local affection, as 
chronic rheumatism, gout, &c. The unfortunate 
patient has been obliged to undergo, in vain, every 
variety of treatment recommended by authors for 
the removal of such complaints ; when, as might 
have been expected, want of success attended their 
labour. Even the horrible supposition of lumbar 
abscess being the cause of the pain, has been en- 
tertained, and bleeding, blistering, with the use of 
setons, have been obstinately persisted in for its re- 
moval. What might not seem very extraordinary, 
however, the patient remained uncured ; but when 
such means were applied as were suitable for the 
removal of the complaint, the rheumatism, or lum- 
bar abscess, or whatever term they chose to give it, 
entirely disappeared. 

I shall now endeavour to illustrate the preceding 
diseases, by the relation of a few cases. 



261 



CASE. 

An unmarried Lady, aged 21, of a delicate habit 
of body, menstruated at the usual period, without 
any symptom but such as are common on these oc- 
casions ; and her health in every respect continued 
unimpaired fully two years : She was at that time 
attending a boarding school, and had exposed her- 
self to cold and too much fatigue, in consequence of 
which her health suffered considerably. A few 
months after, her menstruation was greatly diminish- 
ed in quantity, and, although it always preserved the 
regular period, was attended with most excruciating 
pain, particularly on the first day after its com-, 
mencement. Warm applications, and sometimes fric- 
tion, with an occasional laxative pill, were the only 
remedies she ever employed. From these, she de- 
rived only momentary relief; for, at each return of 
her menstruation, the same sort of applications were 
uniformly and necessarily had recourse to with simi- 
lar partial benefit. In addition to her other com- 
plaints, she had, for more than a year past, been af- 
flicted with most distressing sickness and retching, 
a day or two previous to the flow of her menses. 
This, however, in general disappeared on their ap- 
proach. About this time, too, her other complaints 
likewise subsided considerably ; but several days 
elapsed before she recovered from the great degree 
of debility probably induced by them. She never 
had any leuccorrhoea. 

When I was desired to visit this lady, I found her 
very much emaciated, of a very costive habit, with 
a fluttering and irregular pulse. Having been in- 
formed by her mother respecting the state of her 
complaints, 1 judged it improper to question her a- 
bout them, as her feelings were of a very delicate 
kind. I explained to her mother what I conceived 
to be the nature of her complaints, and proposed to 
r 3 



262 

try the effects of the tincture of cantharides in re- 
moving them. In order to obviate the costiveness, 
I prescribed a pill composed of hyociamus and aloes, 
and next day prescribed the tincture of cantharides. 
I ordered her to be bathed in tepid water every night, 
and a flannel or thick cotton fhift to be worn in pre- 
ference to any other. This practice was continued, 
though sometimes rather irregularly, till next return 
of the menstruation ; but there was no abatement in 
the violence of the symptoms above described. I 
now, with some difficulty, prevailed on this lady to 
continue the above prescription for another month. 
I desired her to take a good deal of exercise, on foot, 
and in a carriage. During the use of the canthari- 
des, she never was sensible of any pain from it ; and 
at her next menstrual period she did not, as former- 
ly, experience sickness or retching. The other symp- 
toms, however, remained as before, and the cantha- 
rides were continued. 

Three successive menstrual periods returned, and 
she suffered no uneassiness whatever. The only 
medicine which she then used, was the pills of hyo- 
ciamus and aloes. 

A year after she remained in good health, was 
much improved in her appearance, and her men- 
strual periods were regular and gave her no pain. 

CASE. 

An unmarried Lady, aged 19, apparently re- 
markably stout, had her menstruation a few months 
before her fourteenth year. For about a year af- 
terward, this evacuation continued perfectly regular, 
when, at some of the periods, it began to intermit, 
and occasionally to give her considerable pain. This 
irregularity was attributed (and probably with jus- 
tice) to her habit of dressing very thinly, and of re- 
futing to encumber her shape with dress even in the 
night air, or in cold and intemperate weather. Her 



263 

menstruation at length entirely disappeared, and, 
when I first visited her, she had had no appearance of 
it for about two years. Still, however, she continued 
stout, having no complaint but edematous swellings 
in her ancles every night before going to bed, which 
disappeared before morning ; and she was occasional- 
ly affected with sickness and retching which distres- 
sed her very much. 

In this state she applied to me, and her mother 
gave me the above account of the nature and pro- 
gress of her complaints. As it is by no means an 
uncommon occurrence in our profession, for a slight 
effect to become itself a powerful cause, I, having 
seen many cases nearly resembling this, concluded 
that the exposure to cold had, which is by no means 
uncommon, affected the uterine system, and caused 
all the distresses which followed. 

For this patient 1 prescribed the tincture of can- 
tharides, of which she began by taking about half 
an ounce daily in water. In a fortnight, she was 
seized with pain and difficulty in voiding urine. She 
continued to vary the dose according to its effects on 
the urinary organs for three weeks longer, when a 
profuse fetid discharge took place per vaginam, and 
continued several days. I still, however, desired her 
to continue the medicine, and in about ten days the 
discharge entirely disappeared. She continued the 
medicine another month, when her abdomen swelled 
considerably, and she observed also that the swelling 
in her feet was considerably encreased; indeed so 
much so, that she could scarcely wear shoes. The 
swelling of her abdomen became at last so great, 
that she seemed like a woman at least seven months 
pregnant. I still, however, persisted in the use of 
the medicine, and advised her to use friction with 
the hand for the relief of the swelling of her feet. 
About a fortnight after this, the discharge again re- 
turned, and the swelling in her abdomen in about 
one day entirely subsided. The discharge, however, 
R 4 



264 

continued several days more, and again disappeared ; 
but, all this time, she experienced no feeling, or had 
any appearance of a return of the catamenia. I still 
desired the medicine to be continued, as well as the 
friction, which seemed to produce very good effect 
in alleviating the swellings in her feet. She now 
felt pains, though not very severe, all over her bo- 
dy, as if she had been exposed to cold, especially 
about the region of the left kidney, over the left 
ovarium, and in her left breast, which at one time 
became blue as if bruised. Neither of these, how- 
ever, were aggravated by pressure, and I desired her 
to continue the medicine &-c. as formerly directed. 

No remarkable alteration took place for about four 
months, except the frequent occurrence of pain in 
the left ovarium and left breast, which, as formerly, 
became blue, when, after continuing the medicine 
with the utmost patience, she had a slight appear- 
ance of the catamenia, attended v\ ith considerable 
pain. She still persisted in the use of the medicine, 
and in three months more, J judged it necessary to 
withdraw it, as, for two months previous to that, the 
catamenia had been, in every respect, regular and 
natural. Several months have since elapsed, and 
she still continues in perfect health. 

CASE. 

A married lady, aged 24, had her courses at the 
usual period, and was in every respect stout and in 
good health till about her twentieth year. During 
menstruation she, about that time, was exposed to 
cold, and had got wet feet, which was the cause of 
her menstruation stopping before the usual period. 
Although for six months afterward, she had no dis- 
charge of this nature, her general health was not 
in the least degree impaired She was then affect- 
ed with flooding, which, independently of all the 
means she could uae to stop it, continued incessant- 



165 

ly for three weeks ; but, instead of having the 
regular return of her courses, she was now ill once 
in three weeks, and, instead of their continuance 
being only three days, they continued now five, six, 
or seven days at each period. In May" 1808, she 
was again, without any visible cause, affected with 
flooding, and when it stopped, she was affected with 
frequent headachs and sickness, accompanied by a 
frequent sensation as if she would menstruate, but 
this did not occur. She now began to increase in 
size, and her accoucheur assured her that she was 
"pregnant, and what convinced her of the truth of 
this, was the sensation of a motion which she dis- 
tinctly felt, and which resembled that of the foetus. 
Still, about the end of every month, she felt as if 
she was about to menstruate, and she had even a 
slight discharge, but still she encreased in size. A- 
bout this time, she became weak, faint, and greatly 
debilitated; and, about the end of January l&Og, 
the bulky appearance, which she had been previ- 
ously taught to believe owed its existence to preg- 
nancy, suddenly disappeared in the course of a few 
hours without causing any discharge. She was now 
greatly enfeebled, and, about the beginning of 
March, when I visited her for the first time, she in- 
formed me, that for several weeks before, she had 
been in the habit of using a great variety of differ- 
ent medicines, but derived no benefit from them. 

I conceived myself warranted, from the general 
circumstances of this lady's case, to prescribe the 
tincture of cantharides, to be taken at first in doses 
of about two drams daily ; she progressively increas- 
ed the doses for about five weeks, when she could 
take nearly an ounce per diem. At this period, 
too, she had a return of her menstruation, which 
seemed quite natural, and lasted three days ; and 
a few days previous to this also, a curious cir- 
cumstance occurred, which I cannot avoid men- 
tioning in this place. In the early part of this la- 



266 

dy's life, when her menstruation was quite regular, 
she had always a sensation of fullness in her breasts 
a few days previous to the occurrence of the men- 
strual discharge, which went off when that discharge 
appeared. From her twentieth year till now, she 
never had had such feeling ; but, a few days previ- 
ous to the present return, the same fullness in her 
breasts occurred, accompanied by all the sensations 
which she usually felt when she was in good health, 
and when that discharge was natural. I still desired 
her to take the cantharides in sufficient doses to occa- 
sion slight pain ; but now she felt that a much smal- • 
ler dose was sufficient for that purpose than formerly. 
She, therefore, continued to decrease the doses, and 
about the expiration of another month, two drams 
per diem was a sufficiently full dose. I had desir- 
ed her, for several weeks preceding, to use cold sea 
bathing, which agreed with her very well, and about 
the time she expected a return of her menstruation, 
she went to bathe. On going into the water, but 
not previous to it, she felt a sensation as if her men- 
struation was just about to return ; she, however, 
continued in the sea for sometime after. On her 
return home, no similar sensation affected her, but 
still she continued to use the cantharides ; the full- 
ness of her breasts, however, frequently troubled 
her, and from time to time, she felt as if her men- 
struation would return, but it did not. She had^ 
now become remarkably stout, as much indeed, if 
not more so, than ever she was in her life. ; 

After continuing the regular administration of the 
cantharides for another month, anxiously expecting 
a return of her menstruation, and that her health 
would then be permanently restored, her disap- 
pointment was inconceivable, when the expected^ 
period elapsed without the smallest appearance of 
such discharge. Indeed, at this time, she did not 
experience even the slightest sensation, either in her 
breasts or elsewhere, which might give her hopes of 



267 

what she so anxiously expected. Still, however, 
she resolved to continue the use of the cantharides, 
a dram each day of which was now sufficient to 
produce as much pain in passing water as an ounce 
did formerly. The first fortnight elapsed, but she 
had no alteration in her feelings which might give 
her any encouragement to proceed, and she had 
now almost resolved to abandon the medicine. A- 
bout this time, however, she again began to feel 
some degree of fullness in her breasts, which gradu- 
ally encreased, and, in four or five days more, her 
breasts, still increasing in fulless, became painful, 
even to such a degree, that she could scarcely al- 
low the weight of clothes to press upon them. Af- 
ter remaining in this state for about ten days more, 
her feelings exactly corresponding with what they 
were on similar occasions when she was in perfect 
health, her menstruation commenced. The dis- 
charge was quite natural in every respect, and also, 
as usual, continued about three days. 

The sensation in her breasts disappeared with 
the cessation of her catamenia, and I desired her to 
continue the use of the cantharides ; but the fulness 
in her breasts returned in about a week, and, in a 
few days more, became so very troublesome, that I 
judged it proper to withdraw the medicine. This 
had the desired effect, for the disagreeble sensation 
in her breasts subsided considerably, but still conti- 
nued in some degree till the expiration of 29 days 
from her former menstruation, when she again had 
a return of the catamenia. This continued three 
days, and she is now, in every respect, in perfect 
health. 

CASE. 

A lady, aged 25, had her menstruation at the 
usual period, and, after continuing regular for seve- 
ral years, went entirely off. Still, however, her 






26s 

health continued unimpaired, and she consequently 
suffered no inconvenience from the above circum- 
stance. I was desired to visit her in consequence 
of what she termed headachs, which had occasional- 
ly troubled her for fourteen months, and she re- 
marked, that for the above period she had suffered 
considerable debility but no pain, except the head- 
aches. For the two last months, however, she con- 
fessed, that from the frequent excruciating pains that 
affected her rapidly with her encreasing state of debi- 
lity, she was then in the greatest possible distress. 
Her bowels were constipated, her feet and ancles 
edematous, pain in her loins and head was almost 
continual, and, for the last few weeks, frequent and 
small evacuation of her menses, attended by excru- 
ciating torture, had almost reduced her to a state of 
delirium ; yet headachs, according to her first state- 
ment, was her only complaint. This is one instance 
of the difficulty of extorting from some ladies the 
exact state of their complaints. 

From the general state of debility in this case, I 
did not hesitate instantly to begin the free use of 
the tincture of cantharides. This medicine she con- 
tinued for several months, gradually encreasing or 
diminishing the doses as was found necessary ; when 
her menstruation became less frequent, and almost 
entirely unattended by pain. Her general health 
too recovered considerably, and I ordered her to go 
a few miles into the country, from which she has 
now returned completely recovered. 

CASE. 

This case was, in the history of it, similar to the 
last. The lady seemed stout, healthy, and animated. 
Her pulse, however, was small, and only beat about 
60 per minute. On this account, as the severity of 
the symptoms had not yet arrived at such a pitch as 
the last, I deemed myself fully warranted to use the 



269 

most active means for the removal of these symptoms 
before they arrived at such a pitch of disease. I con- 
sequently desired her to commence the use of the 
cantharides, which nothing but the fear of what 
might occur, induced her to comply with, as she then 
felt no inconvenience from her complaint. She there- 
fore commenced, and in 14 days she had slight pain 
in passing water, from the operation of the medi- 
cine, and the following day there was a slight dis- 
charge, seemingly of the menstrual fluid, but it went 
off in about an hour. Under proper directions, she 
continued to take the medicine for three months 
when her menstruation became perfectly regular and" 
natural, and she had not taken any of that medicine 
for several months. 

CASE. 

Miss , aged 22, stoutly made, but very 

pale, and of a sickly appearance, was, when an infant, 
affected with great pain in the under part of her ab- 
domen. This, from her indistinct account of it, was 
mistaken for a bowel complaint, and treated as such ; 
but she scarcely derived even momentary relief from 
any of the applications that were made. A few years 
after, she was better able to describe the nature of 
her feelings, and it was not till then observed that 
she was affected with leucorrhoea in a slight degree, 
with frequent darting pains all over the generative 
organs, which last sensation was equally sudden in 
its attack, and in its departure. Her urine was of 
the colour and apparent consistence of thick porter, 
and she uniformly experienced partial relief after dis- 
charging a quantity of it. Sometimes for a day or 
two, she remained free from pain ; at other times 
several weeks, without suffering much. 

Her menstruation commenced when she was 1 1 
years of age, but this was only partial, for a year 
elapsed before it continued regularly. Since that 



270 

time, her complaints have been more severe, and she 
has had more frequent returns of them than before 
the menstrual period commenced. Her menstrua- 
tion has been very regular, but in astonishingly small 
quantity, and attended with very great pain about 
her back, and the lower part of her belly. While 
passing urine, it frequently stopped suddenly, and 
then she felt considerable pain, with a sort of convul- 
sive shuddering all over her body. When this left 
her, she felt for several hours a general lassitude, and 
sometimes considerable sickness, and within these 
few months, she was seldom free from the most 
'acute pain. She had used a great variety of medi- 
cines, but from them she derived no benefit. The 
cold and warm bath have been repeatedly employed, 
but both have been equally unsuccessful. 

The long continuance of this complaint, with the 
variety of symptoms connected with it, rendered it a 
case of considerable difficulty. I, however, had pre- 
viously seen such a variety of diseases of these parts, 
the causes of which could not be very satisfactorily 
accounted for, but which evidently existed in conse- 
quence of a diseased, for the most part diminished, 
action of the vessels connected with them, that I did 
not hesitate about its nature ; and her pulse being 
extremely feeble, I thought it proper to proceed on 
the supposition of this being the principal cause of 
her complaints. 

On the 8th of November 1807, I prescribed tinct. 
canth. 3fs. aq. font. 3vi ; a table spoonful to be taken 
four times a day. About a week after, she felt slight 
pain in voiding urine, and I requested her to regu- 
late the doses so as to produce this effect in a slight 
degree, but always to avoid taking it when the pain 
became severe. 

On the 1st December, she had a return of her ori- 
ginal complaint, for the first time since she began 
the cantharides ; and although she thought it was 
equally severe, yet it did not affect her in the way 



271 

that it formerly did. The pain formerly seized her 
suddenly, and to a great extent, and its departure was 
equally sudden. Now, the grating and darting pain 
approached gradually, and went off by degrees. No 
other change had taken place in her complaints. I 
therefore ordered the cantharides to be continued. 

On the 6th, she had a slight return of her com- 
plaint, and she suffered some pain from the cantha- 
rides in passing water. Eager to relieve herself from 
the disease, she very inconsiderately took larger doses 
of the cantharides, and in the evening she was seiz- 
ed with most excruciating pain in voiding urine, ac- 
companied by the most violent hysteria. As she 
resided a few miles in the country, it was several 
hours before I saw her, when I immediately ordered 
the application of cloths dipt in warm water to be 
made to the abdomen, and at the same time, pre- 
scribed a smart cathartic. Before the following 
morning she was relieved from the pain, but suffer- 
ed a great deal from general debility. 

On the 9th she recommenced the use of the can- 
tharides in small doses, and informed me that the 
leucorrhoea had completely disappeared. 

On the 1 ) th she had a return of her old com- 
plaint, but thought the pain considerably different 
in its nature from what it had been. 

On the 16th she had several times, since last re- 
port, suffered considerably, in consequence of hav- 
ing used the cantharides rather freely ; but without 
any application for the purpose, it gradually left her 
in a few hours. She uniformly observed, that when 
the pain or difficulty in voiding urine was severe, 
she had a slight return of the leucorrhoea, which 
left her when the pain went off. Her original com- 
plaint, compared to what it was, in severity, was 
now very trifling. The cantharides were still con- 
tinued. 

On the 20th, she had suffered considerably from 
pain in her head, and a sort of feeling as if her face 



2/2 

were swelled, particularly after taking the canthari- 
des. I prescribed an infusion of chamomile flowers 
to my patient, and at the same time desired her to 
continue the cantharides. 

On the 23d, she had experienced great relief 
from the chamomile, and she was scarcely conscious 
of the existence of her original complaint. I there- 
fore ordered the cantharides and chamomile to be 
continued. 

On the 1st of January 1808, this complaint had 
completely disappeared, and her menstruation, 
which took place a day or two before, only troubled 
her about an hour, and the quantity was also very 
trifling ; even less than she ever observed it on for- 
mer occasions. I ordered the cantharides to be con- 
tinued. 

On the 25th she had continued to take the can- 
tharides since last report, except twice, when she 
omitted it for two or three days, and then she had 
a slight return of her original complaint ; and when 
she took it so as to produce a good deal of pain, she al- 
ways had a limpid discharge per vaginam. Her 
menstruation now again commenced without any 
pain ; and I ordered the cantharides still to be con- 
tinued. 

On the 2/ th menstruation had stopt. At this 
time it had been in greater quantity, and continued 
much longer than usual. During the last day of 
it,, however, she suffered a good deal of pain from 
the medicine. I therefore ordered the cantharides 
to be taken in small doses. 

On the J Oth of February, she had no complaint, 
except during sudden changes of the weather, when 
she had a slight degree of her original disease. I 
therefore desired the cantharides to be continued. 

On the ;2th of March, her complaints had en- 
tirely diappeared, and in her general health she was 
much better than ever she recollected having been. 
She had taken no cantharides for several weeks, 



273 

and I had not desired her to commence it ; her ap- 
pearance Mas now much improved. 

It is now confidently and widely asserted, that 
this patient had a cancer in the uterus, and that I 
cured it ; said to be the only instance of the kind 
■ever cured. Unfortunately, however, for such re- 
porters, the lady had no cancer in the womb. 

In October J8O9, this patient continued perfectly 
well. 

CASE. 

Miss , aged 28, was, in early life, un- 
commonly stout, healthy, and possessed of an ex- 
traordinary share of animation. From sudden ex- 
posure to cold, about six years ago, after having 
heated herself by dancing, she was seized with ri- 
gours. Medical assistance was sent for, and she 
apparently recovered ; but when her next menstru- 
al period arrived, instead of the flow, commencing 
as usual, without any troublesome symptom, she 
was, two days previous to its expected appearance, 
seized with very excruciating pains in her back, 
darting down her thighs ; and there was a semi- 
transparent fluid discharged per vaginam in consi- 
derable quantity. Two days afterwards, the acute 
pain still continuing, menstruation commenced, and 
in a few hours the pain in her back, &c. abated. 
Menstruation ceased, as usual, in four days, and 
she in every respect recovered her health, but pains 
of increasing severity continued to harass her for 
ten successive months, at each return of the men- 
strual period, and then, for the first time, she was 
affected with a regular leucorrhceal discharge. She 
at that time resided in London, and although most 
extraordinary quantities of different medicines were 
daily given her, she derived no benefit from them. 
About this time her general health began to suffer 
considerably ; and from the repeated failure of these 



274 

nssurances of complete recovery, which she was 
daily taught to expect, she at length formed a re- 
solution to take no more medicines She became 
discontented, of an irritable temper, and was sel- 
dom entirely free from violent hysteric affections. 
She then came to Edinburgh, where some of her re- 
lations resided, and was again prevailed on to recom- 
mence the use of medicines. Among other pre- 
scriptions, she was purged without mercy, but still 
there was no abatement of her complaints ; and at 
each return of her menstruation, the period of 
which still continued regular, the bearing-downpains, 
as they are called^ were so distressing, that they al- 
most threw her into a fit of delirium. At such times, 
she made use of prodigious quantities of laudanum, 
from which she experienced only momentary relief. 
She was now obliged to confine herself to bed, a 
week before and nearly a fortnight after each men- 
strual evacuation, during which times her suffer- 
ings were indescribable. 

When I was desired to visit her, I found her in 
the greatest possible distress, and was informed by 
her mother of the above circumstances respecting 
her complaints. She was pale, but not in the least 
degree emaciated. It was a sort of paleness more 
frightful than I ever recollect to have seen in any 
person. Her feet and ankles were almost constant- 
ly edematous, and several of the nails of her toes 
had separated from her feet ; and her hair had al- 
most all fallen off. Her pulse was feeble and irre- 
gular. I proposed to try the effects of the tincture 
of cantharides, conceiving it, in this case, to be the 
only medicine that could be of service to her ; but 
I had considerable difficulty in persuading either 
the lady or her relations to try any more medicines, 
as, from the disappointments they had already ex- 
perienced, they expected no benefit from them. 
She, however, at last consented, and I prescribed a 
mixture, each dose of which contained .gfs of the 



275 

tincture of cantharides, which I desired her to take 
thrice a day. She gradually increased the dose, till 
she could use about jfsof the tincture daily, with- 
out suffering the slightest uneasiness in voiding 
urine ; and this quantity she continued to take for 
the space of five weeks. In the interim, her men- 
strual period arrived, but there was at this time no 
alleviation of her former symptoms ; she on the 
contrary thought, if possible, that they were aggra- 
vated. In a few days after, the effect of the medi- 
cine on her urinary organs was felt, but I did not 
see her till the following day. From the time that 
this effect was produced, till I saw her, she had not 
diminished the doses of the medicine, although I 
had desired her to do so when the above symptom 
became troublesome ; and, in consequence of this 
omission, she was now suffering considerable pain* 
I requested her immediately to desist ; prescribed a 
smart cathartic, and recommended the application 
of cloths dipped in warm water to the abdo- 
men. Next day, this disagreeable sensation had a- 
bated, and was completely removed in the morning. 
The leucorrhoeal discharge had increased in quan- 
tity, which alarmed her very much ; and, owing to 
this circumstance, I had again some difficulty to 
prevail on her to recommence the medicine. Next 
return of her menstrual discharge was attended with 
pains equally severe as formerly; but the following 
curious occurrence took place at this time, which I 
never witnessed on any former occasion, or in any 
former patient. Instead of the leucorrhoeal discharge 
being increased in quantity, it entirely disappeared 
one day before, and returned two days after the 
menses had stopped, with increased violence. The 
doses of the medicine were now taken in very small 
quantity, as the urinary organs were easily affected 
by it ; and her pulse had now become full and re- 
gular. Next menstrual period was preceded by no 
pain, but it was considerable during the flow, and 
s2 



176 

the quantity of the menstrual fluid was, at this time, 
truly alarming. This, however, went off in five 
days, when the leucorrhoeal discharge seemed great- 
ly diminished. The severity of her complaint hav- 
ing now relaxed, I desired her to go into the cold 
bath thrice a week. She soon went into the coun- 
try, and, from her habit in using the medicine, I 
requested of her to use it while she was there. I 
heard from her about five weeks afterwards, when 
she informed me that her complaints had almost all 
disappeared, and that her menstruation was not now 
attended by pain. She still, however, complained 
of great general weakness, and said that her appe- 
titewas very bad. I desired her to leave off the use 
of the cantharides, and to substitute for it bark and 
wine in pretty liberal quantities, and, when her ap- 
petite was somewhat restored, to add to these rich 
soup and nourishing diet. 

This lady had not, at the end of six months, im- 
proved much in strength, nor had her colour, in the 
smallest degree, altered for a more healthy appear- 
ance, yet her leucorrhoea was gone, and her men- 
struation had become regular, and without pain, 
and although the hysteric affections were still very 
troublesome, she could now completely subdue them 
by the use of pills composed of assafcetida and opi- 
um. 

In September 1808, this patient had complete- 
ly recovered ; her appearance was greatly improved ; 
she could walk a few miles without being at all fa- 
tigued, and the hysteric affections only troubled her 
when her mind was violently agitated. 

She is now, October 180Q, in good health, not 
being troubled with any vestige of her former com- 
plaints. 

CASE. 

A Widow Lady, aged 45, was, till about two 
years ago, stout and healthy, when her catamenia 



177 

became irregular ; at times, not appearing oftener 
than once in three months, at others once a-fort- 
night. She appeared as if several months gone in 
pregnancy. Her general health became gradually- 
impaired ; her appetite failed ; her bowels were, for 
the most part, torpid, and a teazing cough, with 
difficult expectoration, distressed her every morn- 
ing. She gradually lost her former healthy appear- 
ance, and became discontented and unhappy. 

For the removal of these affections, she princi- 
pally depended on change of situation, but this 
yielded only temporary relief, and that during the 
interval of her menstrual periods alone. When she 
consulted me, she was much debilitated, and willing 
to listen to any rational proposal for the restoration 
of her health. I prescribed the tincture of can- 
tharides, 5ft of which I desired her to take in a glass 
of water thrice a day. 

It may be unnecessary to give the daily reports 
of this case, as nothing uncommon occurred during 
the use of the medicine, but what was to be expected, 
and such as I have formerly detailed in other affec- 
tions. I may, however, remark, that this patient 
continued it sometimes in larger, sometimes in smal- 
ler doses, for nearly three months, before she ex- 
perienced any material advantage from its use. 
About that time the menstrual periods recurred 
more regularly, about once only in two months. 
She still continued to use the medicine, gradually, 
though very slowly, diminishing the doses, when 
all the complaints of her general system having left 
her, she left it off entirely. 

In September I8O9, she had no return of herca- 
tamenia these ten weeks, and she is in perfectly 
good health. 

Several of the casesl have now and formerly detail- 
ed, cannot, according to nosologists, be put under any 
particular head ; their symptoms blend so intimate- 
ly with each other, that, to divide them, in order to 
s 3 



278 

make them suit a particular hypothesis, would be 
depriving the reader of the truth, for what might on- 
ly be imagined to be the truth. I have, therefore, 
followed simple nature, which is seldom incorrect, 
and have detailed such cases only as may seem in- 
teresting or instructive. 

As I have now collected, in the present work, the 
most important of those cases which I have, on va- 
rious occassons, and in various places, published 
on the different diseases of which I have treated, 
which clearly illustrate the points I was most anxi- 
ous to prove, I shall, in future, unless they be of a 
very rare nature, decline publishing any others, as 
I know that many persons, however general the 
detail may be, do not wish to have their cases taken 
notice of in books. Patients, influenced by these 
motives, have particularly requested of me, after the 
cure of their complaints, not to publish an account 
of them. The religious attention which I always 
pay to these requests, has thus prevented me from 
mentioning many curious circumstances connected 
with some of them, which could have been, with 
considerable advantage, delivered in the form of a 
case. Where this has occurred, I have inserted 
the general remarks, either on the nature or cure 
of such cases, according as the general circumstan- 
ces respecting them required that they should be 
inserted at either of these parts. 

From repeated observation, I may add, I now 
judge it proper, in all affections of the generative 
system of the chronic kind, to continue the use of 
of the medicines by which we have effected a remo- 
val of these diseases, for a considerable length of 
time even after all the functions have resumed their 
healthy actions. When this is omitted, the com- 
plaint is extremely apt to recur in a slight degree, 
rendering it necessary to resume the medicine ; 
but, when it is continued from three to six or eight 
weeks after, or, in very severe affections, for several 



279 

months, a return of the symptoms is rarely expe- 
rienced. 

I may conclude by remarking, that even were the 
cantharides to produce relief, in these complaints, 
only during its exhibition, it would still be a very 
valuable medicine. From experience, we find that 
it can be used any length of time, without, in the 
slightest degree, injuring the digestive organs, or 
the health in general. Certainly, therefore, although 
its constant use should be necessary, which fortu- 
nately is not the case, even the disadvantages at- 
tending this would be infinitely less than that the 
patient should be obliged to endure the complaint 
throughout the remainder of life. 



280 



CHAP IV. 



TREATMENT OF GENERATIVE ORGANS COM. 
MON TO BOTH SEXES. 



OF GONORRHOEA. 



General Observations. 

It seems to me a task of the utmost difficulty, 
indeed almost of impossibility, to divide gonorrhoea 
into different stages, and regulate our practice ac- 
cordingly. Some authors, however, divide it into 
the first, second, third, and fourth stages, accor- 
ding to the extent of the canal which they imagine 
to be affected ; and this extent, they think, depends 
greatly on the length of time the disease has exist- 
ed. I deem this, I say, an impossibility, as in va- 
rious cases I have, in a few days after the first at- 
tack, found almost the whole canal, or at least a 
greater part of it, affected, while in others, although 
the disease had existed during several weeks, the 
pain, which probably indicated the extent of the di- 
sease at the time, did not reach more than an inch 
from the orifice of the urethra. These differences 
probably exist more in consequence of some pecu- 
liarity of constitution in the individual, than to 
any thing exclusively connected with the disease. 
While, therefore, this difference of constitution is 
so generally to be met with, an attempt to apply 



281 

general reasoning* when exceptions to general rea- 
soning, and particular attention to existing circum- 
stances, must entirely regulate our proceedings, is 
more likely to lead us astray, than properly to di- 
rect our proceedings. 

It is fortunate, however, that, unless from bad 
treatment on the part of the medical attendant, or, 
what very commonly happens, from the thoughtless- 
ness of the patient, or from the difficulty of manag- 
ing those possessed of strong and ungovernable pas- 
sions, gonorrhoea of itself is almost always an easily 
cured disease. Indeed, we almost always find that 
it is from the above causes alone, if we ever fail in 
curing it in a short time. 

Certainly, then, in the cure of this disease, much 
more caution is requisite, than in general practice 
is bestowed on it. It is not uncommon for almost 
every one, whether of the medical profession or 
not, to conceive himself fully capable of removing 
gonorrhoea, and, under such conceptions, it is not 
usual for medical assistance, especially in its early 
stages, to be required for its cure. But I may 
observe, that there are few complaints, in its usual 
degree of severity, in the removal of which the 
chances of doing injury are so numerous. 

The structure of the parts are, from improper 
treatment, extremely apt to be very seriously de- 
ranged. The delicate membrane, with the glands 
immediately under it, as well as the ducts leading 
from these glands into the urethra, may suffer va- 
rious states or degrees of disease, from improper ap- 
plications. Whether, if these parts should be to- 
tally disorganised, and incapable of being regenera- 
ted, or if they should only suffer partial derange- 
ment, which the powers of nature themselves may 
correct and restore to their healthy functions, is no 
argument in favour of such rude practice as may 
produce such derangement ; for the abilities of a 
medical gentleman ought ever to be directed, not 



282 

only to the cure of disease, but to its cure in the 
very easiest way. 

Mr John Hunter, however, was of opinion that 
medicine is very seldom of any kind of use in gonor- 
rhoea. As this gentleman has gained too high an 
ascendency to be neglected, I think it incumbent 
r •. me to consider this opinion of his somewhat fully. 

* " As we have no specific medicine for gonor- 
rhoea," says he, " it is fortunate that time alone will 
effect a cure ; it is therefore very reasonable to sup- 
pose that every such inflammation gets well of it- 
self; yet, although this appears to be nearly the 
truth, it is worthy of consideration, whether medi- 
cine can be of any kind of service in this form of 
disease. I am inclined to believe, that it is very 
seldom of any kind of use," &c. 

I suspect that these observations of Mr Hunter 
are rather unguarded. If we consider this inflam- 
mation, and its consequences, we shall not hesitate 
to decide, that it is to be treated on the same prin- 
ciple as other local inflammations. 

The violence of the inflammation, to be sure, will 
for the most part abate spontaneously ; but then, a- 
tony of the organs of urine and generation, spasmo- 
dic constrictions, or even condensation of the mem- 
branes, with obstinate gleet, are the almost invari- 
able results ; and with these also, an almost incalcu- 
lable number of very troublesome and dangerous 
complaints, proportioned to the violence and dura- 
tion of the previous inflammation. Thus, the cure 
will certainly be much worse than the disease itself. 
If, indeed, the gonorrhaea has been uncommonly 
slight, it may cute of itself ; but, in the common se- 
verity of such complaints, one form of disease is 
thus only changed for another, and a gleet, remain- 
ing for years, if not for life, will be a very probable 
consequence of an affection thus neglected. This 

* Hunter, Chap. IV. p. 69. on the cure of Gonorr^oe^. 



283 

is but the first effect : the local and general debility 
which it causes, and all that train of inveterate symp- 
toms which arises from such complaints, will inevi- 
tably follow. But the severity of these symptoms 
must greatly depend on the general habit, as well as 
on the manner of living of the person affected. 

That gonorrhoea, however, will not completely 
cure itself, Mr Hunter soon acknowledges : for, 
in page J\, he remarks, " When the inflammation 
has considerably abated, the disease only now re- 
maining in a mild form, it may be attacked either by 
internal remedies, or local applications ; if it be at- 
tacked locally, violence is still to be avoided, because 
it may bring back the irritation. At this period, 
gentle astringents may be applied, with a prospect 
of success ; or, if the disease has become mil !, and 
there are' no signs of an inflammatory disposition, 
either of the common or the irritable ki >d, in order 
to get rid of the specific mode of action quickly, an 
irritating injection may be used, which will increase 
the symptoms for a time ; but when it is left off, 
they will often abate, or wholly disappear. In such 
a state of parts, astringents may be used ; for the 
only thing to be done is, to procure a cessation of 
the discharge, which is now the principal symptom.'' 

This is the very point jvhere, if we have judged 
right, gonorrhoea ends, and gleet begins ; and where, 
of course, the stimulating plan should be adopted, 
with an activity proportioned to the debility that has 
been induced. 

If Mr Hunter alludes to the fact, that the active 
inflammation will abate, and debility ensue, then, in 
this respect, gonorrhoea does not differ from other 
inflammations, and sores of every description : on 
this principle, we need not be told that gonorrhceal 
inflammation exhausts itself, for so will inflamma- 
tion from every other cause. Mr Hunter elsewhere 
seems to be of this opinion. 



284 

In page 10Q, Mr Hunter says, " If any of these 
diseases arise from gonorrhoea, they are most proba- 
bly not the consequences of any specific quality in 
the venereal poison ; but are such as might be pro- 
duced by any common inflammation of those parts, 
as was observed of the continued symptoms." 

On the constitutional treatment of gonorrhoea, 
(page 84) he abandons the notion of this complaint 
curing itself, and advises all the variety of the phlo- 
gistic and antiphlogistic treatment, as shall be indi- 
cated by the symptoms. 

In the ambiguity of Mr Hunter's mode of ex- 
pressing himself, we may often find contradictions 
equally evident. Which of the assertions ought to 
be believed ? 

Although gonorrhoea, in almost every instance, 
terminates by resolution, that is to say, it terminates 
without producing tumor or ulceration, yet, like every 
other inflammatory disease, it may, from various caus- 
es, terminate in suppuration, render some of the af- 
fected parts(scirrhous,jor gangrene may even be in- 
duced. 

It ought, during the cure of this disease, to be an 
invariable rule to use no stimulating food or liquors, 
to avoid exposure to great heat, and to abstain from 
all fatigue or violent exercise of any description, and 
particularly from riding on horseback. 

Modes of Living. 

During the cure, so far as my experience has per- 
mitted me to judge, a strict observance of the mode 
of living is absolutely necessary ; indeed much more 
so than seems necessary during pox. We ought 
to be particularly careful to avoid all high- seasoned 
food, and live on the most simple and easily digest- 
ed kinds. All spirituous liquors must be prohibited, 
and nothing stronger than small beer, spruce, or 
soda water, used. 



285 

Although, however, the use of spirituous liquors 
are almost always hurtful in gonorrhoea, I know a 
gentleman who has been frequently affected with 
that disease, who uniformly cures himself by being 
in a state of continual intoxication for several days 
each time he is affected in this way. By this means, 
he serves two purposes ; he gratifies his propensity 
for debauchery, and he cures his disease : perhaps I 
may add a third, he will soon ruin his constitution, 
and destroy his life. 

During the whole course of this disease, all muci- 
laginous and farinaceous drinks may be used with ad- 
vantage ; indeed they are perhaps the safest a patient 
can use. To these may be added, tea, coffee, &c. 

Sea Bathing. 

In the course of gonorrhoea, cold lavation, and cold 
bathing in the sea, if it can be had, are of the utmost 
importance in every period of the disease. These 
seem, in short, general indications of cure in every 
degree of severity of the disease ; and, even in slight 
affections, these applications alone will effect a most 
perfect cure, without the necessity of injections or 
any other medicines. 

Purgative and Laxative Medicines. 

With respect to the employment of purgative 
medicines during gonorrhoea, I may observe, that I 
never have found them useful, but, in many instances, 
they seemed to irritate and render the parts more 
uneasy than before their exhibition. But when there 
is considerable inflammation of the parts, and when 
the bowels, at the same time, require some laxative 
medicine, moderate doses of cream of tartar and nitre 
obviate these states in the mildest imaginable man- 
ner. 

I 



/ 



fp-«-w-fc.X 



/ e e 



# 



Balsam of Copaiva. 

The administration of a few drops of balsam of 
copaiva, dropped in a little water, is of singular ser- 
vice during gonorrhoea, in removing irritation and 
' ardor urinae, which so frequently accompany that 
disease. But this medicine having been found 
of use in some states of this disease, has been ap- 
plied not only in every stage of it, but also in 
gleet. Failure was not the only consequence, as 
the quantity used often deranged the digestive pow- 
ers so much, that it required many months to restore 
them. y.A*jUmi 

Mercury. 

From the peculiar "nature of the inflammation 
which constitutes gonorrhoea from impure inter- 
course, I believe many have been led, in drawing a 
comparison between it and similar discharges from 
other causes, to conceive this peculiarity to depend 
on its connection with lues venerea, and have acted 
accordingly. But had they been regulated in their 
proceedings by analogy, they would not have acted 
so. We know that the different kinds of inflamma- 
tion on different external parts, arise from different 
causes, appear in different degrees of severity, and 
require totally different plans of treatment for their 
cure ; yet no one has imagined, that in their removal, 
which is almost always effected by external means, 
there remains in the system any latent disease in 
consequence of them. 

If it were even established, that the matter of ve- 
nereal gonorrhoea, when absorbed into the system, 
committed ravages similar to those of lues venerea, 
the local means would need to be accompanied with 
the internal use of mercury. This would be the on- 
ly difference between the treatment of such affec- 
tions of the parts of generation as arise from the ve- 



287 

nereal virus, and those of the same symptoms aris- 
ing from other causes. 

I believe it has become a general rule in practice to 
cure gonorrhoea without the necessity of charging 
the system, as in chancre, &c. with mercury. There 
may perhaps be a few exceptions to this rule, but I 
believe they must be very few, and can only exist 
when the matter of gonorrhoea proceeds from a 
chancre in the urethra, the existence of which, ex- 
cept in the very rarest instances, is with me a ques- 
tionable point, hut when this sta'e of the parts 
does exist, mercury is absolutely necessary for their 
removal. *>k?-£ &f=L<-+^- 

Bougies. 

Mr Home's treatment of gonorrhoea is extremely 
harsh and unwarrantable: Who, it may be asked, but 
one under the influence of the wildest of all whims, 
would ever attempt, in the extremely irritable state 
of the urethra, in the generality of gonorrhoeas, to 
thrust a bougie along the whole or a great part of 
that canal ? Independently of the disease which 
such treatment would in almost every instance 
induce, the pain occasioned by it would be almost 
insupportable. 

Either in this stage of the disease, or when great 
irritation exists along the course of the urethra, which 
sometimes exists even before commencement of the 
running, or even after it has stopt, such a state must 
be treated with much judgment. It may, so far 
as my experience goes, be established as a rule, that 
either bougies or irritating injections, used at such a 
time, must do harm. They may encrease the dis- 
ease, or, which is by no means uncommon, they may 
alter it for an affection of a more serious nature, but 
never will cure it. 

In some cases, when the inflammation and irrita- 
tion are very great, sometimes so much so as to affect 
the bladder, or even if these states have been brought 



283 

on by improper' management, opiate glysters are 
of the very utmost benefit, and the warm bath may 
be used with great advantage. In some cases bleed- 
ing from the arm or perineum may be employed, 
but this must be done with the utmost caution, un- 
less the patient be of a very full and plethoric ha- 
bit. In such states of disease along the urethra or 
in the bladder, either during the discharge or after 
it has entirely subsided, the use of injections of oil, 
and the application of a blister over the loins, or ra- 
ther in the perineum, are of the utmost service; and 
that which renders this application doubly benefici- 
al, is, that it can be applied with equal advantage in 
a lax as in a full habit of body. 

jijfection of Cowpers and Prostate Glands. 

When in gonorrhoea, which sometimes happens, 
the prostate and Cowper's glands suffer temporary 
enlargement ; in the former, leeches applied to the 
parts, the moment the symptom is discovered, is 
the most adviseable practice, while, in the latter, a 
blister applied over the affected glands is more ef- 
fectual. These, however, particularly the former, 
are not diseases of daily occurrence ; indeed, they 
rarely occur unless in scrofulous patients, and even 
then, when the gonorrhoea has been very ill treated. 
I believe them indeed to be, in general, diseases 
more in imagination than in reality. 

Chordee. 

For preventing the exacerbation of chordee, a 
method which I have seldom found fail, if properly 
resorted to, is, to turn the penis upward over the 
symphisis pubes, and lay it there in a state of sus- 
pension by means of a circular bandage or ligature, 
taking care that it be very moderately pressed ; and 



2Bg 

that there be interposed a few folds of cloth be- 
tween the penis and belly. 

This, however, must be done when the penis is 
quite Jlaccid, otherwise the handling of it will the 
sooner bring on the attack. ; but at any time during 
the severest chofdee, flannel soaked in cold water, 
or in a solution of acetis plumbi, put round the pe- 
nis, will remove it, and render that member quite 
flaccid ; and thus we can, whenever we please, pre- 
pare the penis for being so supported. This we 
might even expect to happen reasoning a priori ; 
for we know, that by reflecting the yard upwards, 
we diminish swellings and inflammation of the glans, 
by retarding the flow of blood to these parts : now, 
as we know that chordee only assails during erec- 
tion, or, in other words, is the effect of an inflamed 
surface being distended in consequence of the in- 
flux of blood into the corpora cavernosa, it is not 
difficult to conjecture why the flexion of the penis 
should prevent chordee. 

It often happens, that excoriations of the body 
of the yard, and glans penis, with active inflam- 
mation and chordee, all infest the patient at the 
same time ; in which case, flannel soaked in a so- 
lution of the acetis plumbi, and wrapped round 
the penis, together with the tying above described, 
never fails to mitigate the inflammation, remove the 
pain, and prevent the chordee ; in fine, very great- 
ly facilitates the cure. 

When there is considerable tumefaction, with, 
pain in the whole or part of the penis, attended 
with chordee, the application of leeches, and after- 
wards of saturnine applications, are absolutely neces- 
sary ; but when the glans of the penis are simply 
swelled, which, in some advanced stages of the dis- 
ease, exist even to a considerable extent, these ap- 
plications Will be attended with little or no benefit, 
I am sorry, that in the treatment of these indolent 

.... 



glandular swellings on any part of the body, we are 
still very deficient. 

■ d -ft 
Swelled Testicle, , 

Even during the existence of a weariness or kind 
of soreness in the testicles, I have never found in- 
jections do any harm, particularly if used with cau- 
tion, and of moderate strength ; but when the pain 
is severe, and the testicles are evidently swelled, in- 
jections in general increase the evil in a remarkable 
degree. This is the most frequent effect of improperly 
treated gonorrhoea, and it is most common in the 
early or inflammatory stage of the complaint. 

Our first object in the removal of such an infec- 
tion, is to avoid that by which it was caused. In 
additition to this, ease, low diet, &c, with a great 
deal of patience, are also absolutely necessary, and 
even, in severe cases, confinement to bed. Also the 
suspension of the testicles, with the application of 
leeches, and, when the bleeding caused by the 
leeches has ceased, folds of linen cloth dipped in 
cold vinegary solution of acet. plumb, or in diluted 
goulard, and repeatedly applied over them, will be 
of the very greatest service.^ If the discharge from 
the urethra continues or returns, the means stated 
above, will require to be fewer and less tedious than 
where this has totally stopped We judge, then, of 
this symptom beginning to abate, by the discharge 
from the urethra being increased in quantity ; and 
however favourable other appearances, while no in- 
crease of discharge takes place, the disease in the 
testicle will continue. Thus circumstanced, we 
must have recourse to still more general blood-let- 
ting, proportioned to the strength of the patient ; 
the application of an additional and gnater number 
of leeches ; assiduous attention to fomentation with 
the cold- solutions, and cloths dipped in spirit of 
#ine, and frequently applied over the affected part ; 



CJUl^J 



W~IAa**a~<L 



291 

the greatest attention to the gentle suspension of 
the testicle; the body kept continually in a horizon- 
tal posture, and taking some gentle diaphoretic me- 
dicine, are all pressingly necessary. Strict attention 
to these means will, in every instance, effect our 
purpose. / ' - 

A relapse of this disease, toward the entire dis- 
appearance of the gonorrhoea, is seldom, or indeed 
almost never, equal in severity to the first attack. 
The testicle, I may mention, scarcely ever, from a 
state of inflammation, proceeds to abscess ; if it 
does, it must have been owing to neglect or bad 
treatment. 

It will appear, then, that any application used in 
gonorrhoea, by which the discharge is suddenly 
stopped, is always improper. A return of the dis- 
charge in a few days, in an aggravated degree, is 
the simplest consequence of such treatment ; but 
more commonly such means cause swelling of the 
testicles, and, in addition to them^ a diseased state 
of the lining of the urethra> thus laying the foun- 
dation of most obstinate gleet; 

During swelled testicle, even from the first symp- 
tom of it, all injections should instantly be laid 
aside, as every means to suppress the discharge is 
at that time highly improper. 

When the inflammatory action has in some de- 
gree abated, blisters may be applied with advantage. 
The testicle, even from the commencement of go- 
norrhoea, should be gently suspended by the ban- 
dage made for that purpose ; as it has always seemed 
to me at leasts as proper to prevent a complaint, as 
even to cure it. This ought to be continued for 
several weeks after the inflammation has seemingly 
abated* 

When a testicle thus swells, it is* rarely necessa- 
ry to extirpate it, as it does not, in general, even 
leave behind it any morbid hardness or enlarge- 
ment, which does not ultimately entirely subside 
t2 



1Q1 

Injections. 

In the generality of cases of gonorrhoea, I be- 
lieve no such thing as ulceration exists in the ure- 
thra. But when that disease is accompanied by 
such a violent state of inflammation, which I be- 
lieve may sometimes happen, as entirely destroys 
the organization of one or more parts ; when, by 
the application of any irritating substance, such as 
bougies, the various kinds of injections^ when made 
so strong as to injure the structure of these parts, 
or by employing an improperly formed syringe, I 
have no doubt that, under these or similar circum- 
stances, ulceration may be formed. But still it can 
never be deemed a constant attendant, or indeed at 
all an attendant, on the generality of cases of that 
disease, as it is commonly met with in practice. 

In gonorrhoea, especially from impure connec- 
tion, and perhaps in similar discharges from other 
causes, the efforts of the system are unable to re- 
move the diseased action which the urethra has as- 
sumed, and consequently we found it necessary to 
employ such measures, almost always in the form of 
injection, with the occasional use of internal medi- 
cines, which, while they in some measure allay the 
virulence of the local affection, give the system the 
power of restoring the diseased parts to their wont- 
ed vigour. 

Many objections have been urged, and possibly with 
some degree of reason, against the use of the differ- 
ent kinds of injections in the cure of this disease ; 
but, in our present state of knowledge, they really 
are the best applications, when judiciously applied, in 
the generality of cases, that we know. 

As, then, I conceive injections to be the best me- 
thod of curing gonorrhoea, with which we are at pre- 
sent acquainted, I should imagine their failure in ef- 
fecting the purpose for which they Were employed, 



! 



29» 

m-ay, from circumstances already stated, be easily 
accounted for ; such as too great strength, &c &c. 

Perhaps, for the first two days in the treatment of 
every gonorrhoea, an injection of milk or oil ought 
always to be used. To begin with these too strong, 
occasions a partial destruction of the organization of 
themembrane,which can seldom,but with the greatest 
difficulty, be restored to its healthy state. These er- 
rors entirely rest with the medical attendant, who 
by care and proper instructions might have prevent- 
ed such occurrences. Irregularity of living, and 
too much exercise, particularly on horseback, are 
extremely improper, and must at all times be very 
prejudicial during the existence of such complaints. 
These faults again entirely rest with the patient, 
and, unless guarded against, all the attention a phy- 
sician or surgeon can possibly bestow, must be in- 
effectual. 

We often find, then, from carelessness or rash- 
ness, that the inflammation of the urethra, and even 
of the whole penis, is greatly increased, and the dis- 
charge is stopped. If we again have occasion to use 
injections, one composed of milk and water, or Flo- 
rence oil, will be preferable. 

Lapis tutiae, lapis calaminaris or alumen, either of 
them in the proportion of about two scruples to 
four ounces of distilled water, with the addition, 
particularly to the two former, of about an ounce 
of mucilage of gum-arabic, form very useful injec- 
tions. For the same purpose, we may employ a de- 
coction of oak, or Peruvian bark, or galls, with e-r 
qual parts of lime-water. If these are made astrin- 
gent, so as gently to affect the tongue, when ap- 
plied to it, they form useful and safe injections. 
Gum kino also, in the proportion of a dram to five 
ounces of boiling water, with the addition of a little 
mucilage, is a useful astringent injection. When 
the. disease has abated considerably in its severity, 
but not till then, half a dram of tincture of cantha- 
A t 3 






.■# *< 



j t 



294 

rides to six ounces of water, makes a useful injec- 
tion. 

In almost every injection, the addition of one 
dram of tinctura opii to six ounces of it, is at- 
tended with the best effects 

Those who maintain that gonorrhoea and lues 
of the same nature, recommend, for their cure, 
injections principally composed of preparations of 
mercury ; conceiving that in this form, it is more 
calculated to act on and destroy the disease for 
which it is in this way applied, than any other sort 
of injections which do not contain in their compo- 
sition some of the preparations of mercury. To en- 
ter upon a discussion of the particular relation 
which these diseases bear to each other, I have be- 
fore stated, is not the object I at present propose to 
myself. I may, however, remark, that most medi- 
cal gentlemen now cure gonorrhoea without having 
recourse to mercury in any one form ; but, as in- 
jections composed of some of the preparations of 
mercury, are equally useful with those of another 
nature, such as muriate, or corrosive sublimate of 
mercury dissolved in spirit of wine, and afterwards 
sufficiently diluted with water; calomile dissolved 
in lime-water, &c. I am in the habit of occasionally 
using them with the very greatest advantage. 

lor this purpose, a dram of muriated quicksilver 
may be dissolved in an ounce of spirit of wine, and 
two or three drops of the solution being mixed with 
four ounces of water, may be used as an injection 
six or eight times a-day. It is almost always neces- 
sary, when this solution produces no sensation of 
heat in the parts, gradually and repeatedly to in- 
crease it one or two drops to each four ounces of 
the injection. 

When calomel and lime-water is used as an in- 
jection, it may be proper to add to them some mu- 
cilage of gum-arabic. A scruple of calomel, four 
ounces of lime-water, and an ounce of mucilage, 



295 

and one dram of laudanum, then, forms a very good 
injection. The strength of this, however, like al- 
most every other injection, ought, if necessary, to 
be gradually increased. 

Were I indeed to enumerate all the injections in 
common use, each of which has its advocates, from 
some particularly advantageous quality which each 
is supposed to possess, I should be under the ne- 
cessity of filling a volume on that subject alone. 
But this I deem quite unnecessary, as but a very 
few of them may answer every purpose for which 
they are intended. For my own part, I am fully 
satisfied with my success, from the occasional use 
of two or three of different sorts, to suit the diffe- 
rent degrees of severity of the disease, and the pe- 
culiarity of habit of the individual who may employ 
them. 

Those I have last mentioned, have for their basis 
a mercurial preparation, and the other two which I 
shall now mention, have for their basis a vitriolic 
preparation, viz. the vitriolated zinc and vitriolated 
copper. The first of these I prefer in the early sta- 
ges of the disease. I use one scruple, with one 
ounce of gum-arabic, a dram of tinctura opii and 
five ounces of water. As usual I gradually increase 
the strength of this solution, till the quantity of the 
vitriolic preparation amounts to half a dram. The 
latter I prefer, when the discharge has nearly sub- 
sided, and when the last mentioned injection does 
not, which not unfrequently happens, seem to pro- 
duce any beneficial effects on it. The proportions 
I find to answer best with the vitriolated copper, 
are, at first, about 10 grains, an ounce of mucilage, 
and five ounces of water. This also 1 find neces- 
sary to increase in strength, if it does not very 
speedily remove the discharge. 

The best form of a syringe, is that with a coni- 
cal point gradually becoming thicker for at least 
half an inch from the point. This is much prefe- 
t4 , 



rable to those with a small point, which, as it is in- 
troduced some length into the urethra, is apt to 
rupture the part to which it is applied. The for- 
mer, which enters but a short way into the urethra, 
when introduced into the orifice, has no chance of 
rupturing it, and steadily pressed forward, complete- 
ly fills the urethra, and allows the injection more 
certainly to be thrown into the cana), than the o- 
ther with the small point. 

Every particular kind of injection for the remo- 
val of this disease, has had its abetters and support- 
ers, more perhaps from some particular whim, than 
from unprejudiced, accurate, observation. Although 
in the list of those injections in common use, there 
certainly are some preferable to others, yet I have 
never seen any of them do material injury, if used 
in that degree of strength, &c. which is absolutely 
necessary, and from which alone we have any right 
to expect success. 

I should, therefore, be apt to imagine, that the 
difference of opinion which have always existed on 
this subject, must have arisen more from the error 
of the physician, than from any peculiarities with 
which the substance itself was possessed. 

Different constitutions being differently affected 
by the disease, certainly render it necessary for us 
to employ various injections ; and different states 
of the disease, even in the same individual, often 
render it necessary occasionally to vary our applica- 
tions. We are, therefore, if we mean to treat the 
complaint successfully, perfectly correct in chang- 
ing the injection, to suit these different states. 

Some practitioners of great eminence are wrong, 
in forbidding the use of sedative injections, till the 
inflammation of gonorrhoea has greatly exhausted 
itself. 

If I may be allowed to speak from my own expe- 
rience, I would affirm, that such injections are most 
conspicuously useful, when ttye inflammation is most 



2Q7 

violent ; and that, in such cases, cooling solutions 
are not only to be injected assiduously into the 
urethra, but flannel soaked in them, and wrapped 
round the penis, which is done with the best effect, 
and great relief to the patient, in chordee, phymosis, 
paraphymosis, &c. 

To be sure, sympathetic buboes, or, at least, pain 
in one or both groins, are sometimes consequences f 
such active treatment ; but these are in a few hours 
removed by a sponge wet with the same solution, 
and applied to the groin, together with the exhibi- 
tion of a smart cathartic. 

When a violent inflammation is present, we ought, 
both previous to and along with injections, to apply 
leeches to the perineum. Probably the variety of 
injections daily employed, act nearly on the same 
principle. This indeed is the only excuse for the in- 
discriminate use of so many of them as we find in 
common use in every stage of the disease. It seems 
to me, that the strength of these substances is seldom 
if ever properly regulated according to the states of 
violence or different stages of gonorrhoea. They are 
too often indiscriminately applied, and too often 
very erroneously ; still it seems a good general rule 
to use them at first much weaker than afterwards, 
when the violence of the symptoms have begun to 
abate. 

Every one must have observed, in the treatment 
of this disease, that, if the discharge be suddenly 
stopped by strong injections, or otherwise, the inflam- 
matory symptoms at once become worse ; the parts 
are, in a greater or less degree, swelled ; chordee 
supervenes ; and, until these symptoms are sub- 
dued by leeches applied to the perineum, or large 
~~. emollient poultices over the parts, the symptoms do 

not suffer the least abatement, often for several days. 

1 have repeatedly observed, where it can conve- 
niently be done, that, particularly early in the dis- 
ease, weak injections used once every hour, are more 



208 

certainly and more permanently beneficial, than 
when used only twice a-day or so, and from their 
strength at each application, occassoning a consider- 
able degree of pain. In the first, before the previ- 
ous portion of injected fluid has ceased to act, the 
second is applied in this way, and the effect is never al- 
lowed to ce ise. Thus, they effect a care without 
injuring the parts to which they are applied ; but, 
in the latter, they less or more injure the membrane 
which often requires several weeks, or even months, 
to recover itself, under the most judicious treatment. 

Indeed, from much experience, 1 am fully of opi- 
nion that no injection of any one kind ought to be 
used more than three, or at most four days. I have 
found that this plan of altering the nature of injec- 
tions employed, and even, after using two or three 
different kinds, to return perhaps to the one which 
we first employed, is attended with the happiest con- 
sequences. 

We ought not even entirely to abandon the use 
of injections the moment the discharge stops, nor 
is it necessary to continue them even so strong as 
late in the disease before the discharge has stopt; but 
we may, with the utmost propriety, render them 
much weaker than formerly, and continue gradually 
to dilute them till the discharge has disappeared du- 
ring at least four days 

If, in a recent case of gonorrhoea, an injection be 
repeated for sometime, and if, at the intervals du- 
ring the use of it, the inflammation appears to have 
subsided ; if the discharge becomes somewhat thicker 
than formerly, which is usually a favourable symp- 
tom ; yet if at this period the injection be with- 
drawn before the discharge has entirely ceased, in 
the course of a few days the inflammatory symp- 
toms will again recover their force, and become as 
oMinate as before the use of the injection. It is 
therefore necessary, to a complete and permanent 
cure, that the venereal irritation be completely ex- 
tinguifhed, previous to our leaving off the injedion. 



299 

Much confusion has existed in practice, and does 
exist in the works of some authors, respecting the 
manner in which injections into Che urethra act, in 
removing gonorrhoea. Many of them solely direct 
their attention to the alterations produced on the 
secreted matter, without once paying the slightest at- 
tention to the parts which secrete it. By this ne- 
glect, every thing that can be beneficial is over- 
looked. It is to the disease of the secreting surface 
alone, that we are to apply our remedies, and the 
various external applications, and internal remedies, 
muft, by removing its morbid action, remove the 
disease 

I may observe, then, that they seem to produce 
their beneficial effects by altering the action already 
existing in the urethra, which may be done either 
by gently ("and for a length of time corresponding 
to the inveteracy of the disease) stimulating the 
parts, or by acting upon them by their astringent 
qualities. For this purpose, weak injections, as al- 
ready stated, answer best at first, and they may, un- 
der proper regulations, be either altered in their qua- 
lities, or increased in their strength, as the changes 
which take place in the disease indicate. On the 
contrary, strong injections at first will always be 
injurious, by disorganizing, in a greater or less degree, 
the parts to which they are immediately applied, and 
thus requiring a great lapse of time, as well as the 
judicious application of other remedies before the 
parts can in any instance be brought back even to 
their former state. 

A properly treated gonorrhoea, when prescribed 
for on the first or second day after it has appeared, 
ought never to remain beyond a fortnight at the very 
farthest. Even ten days is sufficient, to cure at least 
three-fourths of those generally met with in prac- 
tice. Still much must depend both on the atten- 
tion of the patient, and of the medical attendant. 
For if the patient fatigues himself, lives irregularly, 

- 



300 

and uses his medicines only when perfectly conveni- 
ent for himself, he cannot reasonably expect such a 
speedy recovery. Or if his medical attendant, which 
not unfrequently happens, is little in the way of 
treating such complaints, his hopes of cure, at least 
for the first ten days or a fortnight, must be very 
moderate. 

We uniformly find, I may again remark, and I 
wish particularly to impress it, that whatever sort of 
injections we may think proper to use, especially 
during the early stage of the complaint, when the 
urethra is very irritable, the use of strong substances, 
or violent means of any kind, are always hurtful.' M ! ^'^ 
Indeed, I believe it is in this stage of gonnorhoea 
when the urethra is most apt to be injured, and dur- 
ing which the foundation for the most obstinate 
gleets is laid. Later in the disease, when the irri- 
tation has, in some measure, abated, we may not only 
use greater. familiarities with the system in general, 
but the use of much stronger injections than were 
at first employed, are not so likely to be productive 
of harm. 

I am fully of opinion, then, that it is never the 
use of weak but of strong acrid substances, to which 
we must attribute the unpleasant occurrences which 
are too often to be met with in the treatment of this 
disease. It is owing to this improper practice, which 
is sometimes adopted from an idea, that by it the 
discharge is sooner removed, that unpleasant conse- 
quences so often follow. By it the discharge may 
be suppressed for a short time, but still the parts ' 
continue in a state of great uneasiness, and, in a few 
days it returns worse than ever. 

We find it stated by those who recommend strong 
irritating injections, so that the discharge shall be 
suddenly stopt by them, to throw up the urethra 
•warm oil and other emollients, in order to attempt 
the bringing back the discharge, and thus again bring 
matters where they were. Provided, indeed., we 



301 

could ascertain that no injury had been done to the 
parts by such rude practice, previous to the em- 
ployment of the oil, &-c. it would be of great bene- 
fit ; but when it is recollected, that these parts suf- 
fer the injury the moment the irritating injections 
reaches them, our hopes must not be so sanguine 
from inducing a return df the discharge. Our at- 
tention ought always to be exerted to prevent such 
blunders. 

About the time when the discharge, from the re- 
medies formerly applied, has nearly ceased, it has 
even been recommended by authors, that the pa- 
tient should squeeze the penis, to ascertain whether 
or not the discharge had entirely abated ; but if the 
complaint existed, no such practice would be at all 
necessary. By such absurd means the discharge 
almost always is protracted, and injections are again 
employed for its removal, and thus gleet is almost 
invariably produced. This is unnecessary, for if the 
mildnes of the complaint requires squeezing to make 
it visible, it may be conceived in every instance to be 
very nearly cured. 

The usual violence of the discharge will often 
nearly disappear, and there may continue a small 
discharge, which injections often increase, but sel- 
dom entirely remove. Under these circumstances, 
have often observed, that a change of air, or a journey 
for a few miles into the country, with the use of cold 
x lavation or cold bathing, entirely remove the com- 
plaint in a very few days. This circumstance must 
often have occurred in the practice of those who 
are in the habit of seeing many of these complaints. 

Those cases which are most distressing, both to 
the patient and physician, are such as occur in scro- 
fulous habits. The common vitriolic or mercurial 
injections, seem to have very little effect upon them, 
and, by a continuance of either of these, a very 
great proportion of such cases terminate in the most 
obstinate gleet. Under these circumstances, I have 

■ *'■ tu. JV " ' 






302 

used, with the greatest success, an injection compos- 
ed of two or three drams of laudanum, an ounce 
of mucilage of gum-arabic, and five ounces of water. 
This I have gradually encreased in strength till a 
cure was completed. 

When there is a deep seated dull pain felt near 
the anus, causing much uneasiness to the patient, 
and even preventing him from sitting, besides the use 
of injections, we ought to use an opiate and an opi- 
glyster, with the daily use of the warm bath, which, 
separately or together, seldom fail of removing such 
a sensation. 

Cure of Gonorrhoea in Women. 

If, immediately after suspicious connection, the 
patient washes herself either with a solution of soap 
or vegetable alkali in water, I have no doubt that, 
from the construction of the parts, and the ease with 
which that operation can be performed, either by 
means of the hand or spunge, that there is no danger 
of the infection taking place. 

As the seat of this disease in women is most com- 
monly in the vagina, and as this part can, with- 
out suffering greatly from irritation, admit of injec- 
tions of much greater strength being used, we ought 
at once to begin with them at least double the 
strength that we would use were the Gomplaint to 
affect the urethra. / 



tj\ 



303 



OF LUES VENEREA. 



General Observations. 

I sincerely believe, from the appearance of some 
cases which have occurred to me in practice, that 
there are certain habits in which lues venerea is not 
only extremely difficult of cure, but even incapable 
of being thoroughly removed by the most careful 
administration of mercury. In such unfortunate in- 
stances, mercury, in whatever quantity or form we 
may use it, seems only to blunt the violence of the 
disease, but has no power in completely destroying 
it. For, in a longer or shorter time after the pa- 
tient has ceased to use this substance, the disease, in 
one or other form recurs, and although it may be 
thus frequently checked, is never destroyed. 

Prevention. 

Although I believe that preventatives of venereal 
infection are not much to be relied on, yet, in the 
form of the various washes they may be used, and 
perhaps sometimes with advantage. As promoting 
cleanliness, the use of them is at all times commend- 
able. 

If any benefit is to be derived from them, it must 
be from such as will mix with and wash off the in- 
fecting matter ; and as alkaline substances perhaps 
answer best for this purpose, they ought to be pre- 
ferred. Thus, soap and water, or a solution of ve- 






A 



304 

getable alkali, are perhaps those from which the 
greatest benefit is to be expected, 

Chancres. 

The cure of lues venerea is more or less easily ef- 
fected, according to thej>arts which it affects. We 
almost uniformly find, that while the disease is re- 
cent, and in the form of chancre, it is removed with 
the greatest ease and rapidity. In short, when the 
disease exists in the soft parts in general, it is more 
easily eradicated than after it has affected the 
bones. 

When eruptions or sores break, out on any part 
of the penis, often continuing from time to time for 
months, which, in some measure resemble chancres, 
but which, from various circumstances, ive know can- 
not be that disease, the treatment I usually employ 
with success, is to burn them two or three or more 
days, with some caustic substance, and then leaving 
that off, to apply a piece of charpee dipt in Florence 
oil, for a few days more. This seldom fails of ef- 
fecting a complete cure. But we ought, previous 
to such burning, accurately to ascertain whether 
or not they really are or are not chancres. 

As chancres exist not merely in consequence of an 
affection of the part on which they appear, but only 
as an external symptom of disease of the general ha- 
bit, the application of caustic substances of any sort, 
for their removal, is at least useless, if not highly 
prejudicial When such applications are made ear- & 
ly in the disease, or during its most inflammatory 
stage, buboes in the groin are almost always the con- 
sequence, and if, by such applications, the exter- 
nal sore is healed, we have no proof that the disease 
has been destroyed in the system, even should no 
such consequences be produced. If such practice 
be at all allowable, it is only after a sufficient quan- 
tity of mercury has been taken to destroy the vene- 



305 

rial virus, and when the sore has assumed a hard- 
ness, or indolence about the edges, during the exis- 
tence of which no sore can heal till such a callous 
state be removed by caustic, the knife, or some o- 
ther equally effe&ual means. 

When it can be proved, (which I believe any one 
will find some difficulty in doing,) that chancre is the 
first effect of venereal infection, and that from it the 
constitution is gradually contaminated, then exter- 
nal applications of various kinds may with propriety, 
in a great proportion of cases, be, on its first ap- 
pearance, alone, or in combination with mercury, 
depended on for its removal. But when we reflect 
that chancres are only the effect of the constitutional 
disease, that, in some, they appear in a few days, in 
others, not for several weeks, we shall at once see 
the impropriety of placing dependence on these ex- 
ternal escarotics, at least till the constitutional disease 
has been subdued. 

Could these gentlemen, who argue in favor of 
chancres being the first sign of the venereal virus 
having seized upon the part, and who practise accord- 
ingly, rather than an effect of its more extended ac- 
tion, prove to us, by any mark or sign, the exact 
A ^.period when external escarotics, for instance, might 
alone be successful in destroying the infection, then 
their opinions might have some weight ; but, when 
we hear this important part of the subject treated in 
the most general way ; — when we hear one author 
echoing another, according to the particular respect 
he may have had for his private character, or his 
professional abilities, without his even attempting to 
give any specific reason for his conduct, we are 
bound, as servants of the public, to doubt his asser- 
tions, however high he may stand in public estima- 
tion. 

Not only from what I have actually witnessed, 
but from what I know of the practice of those who 
invariably adopt this uncertain mode of removing 
u 



306 

chancres, merely because some great man or other 
has advised it, and because they themselves have 
seen it repeatedly succeed without producing imme- 
diate bad effects, I am sure that much future misery 
has been occasioned. Such vague and unsatisfac- 
tory advices, therefore, I conceive to be injurious 
in perhaps three-fourths of all the cases treated in 
such a manner. The first effects of such proceed- 
ings are certainly bad, but the after consequences 
are worse. We know that there is no disease which 
can at once entail such deformity, and render the 
sufferer so completely miserable, as an imperfect- 
ly cured or improperly treated pox. Death itself 
would be enviable, compared to what some are thus 
doomed to endure ; and what renders the horror of 
their situation beyond either description or compari- 
son is, that their mental faculties, at least till a very 
advanced period of the disease, almost always pre- -*\ 
serve their former vigour, and are consequently alive *""* 
to all their accumulated wretchedness. 

It is very evident, then, that the application of 
escarotic substances to chancres, is, unless in their 
very protracted stages, when we are sure the virus 
is destroyed, a very hazardous practice, and even, I 
should imagine, unless under the immediate obser- 
vation of one who from practice ought to know the 
absolute necessity of such measures, from certain 
appearances of the sore, it ought never to be at- 
tempted. / 7 ( l I 

I am aware, that very ingenious arguments have 
been adduced in favour of external applications, to 
cure the chancre, being assiduously applied at the 
same time with the internal use of mercury. But, 
from extensive opportunities of observation, I decid- 
edly object to them, as I conceive, as formerly stat- 
ed, chancres in general rather to be the effect than 
the cause of absorption. We find that the advan- 
tages, (for we will sometimes succeed in this way,) 
which may be derived from such practice, in healing 

s j*r 






307 

the chancre more speedily, are not at all to be com- 
pared with the chances of such treatment either im- 
mediately causing buboes, or in deceiving us by heal- 
ing the parts before the venereal virus be destroyed; 
and thereby rendering the chances of secondary 
symptoms more certain. The best external applica- 
tion is, merely to keep the parts clean. 

The danger, then, of applying caustic substances 
to recent chancres, is proved by the following pas- 
sage from Mr Benjamin Bell's second volume on ve- 
nereal complaints, (page 322.) " Of twenty pa- 
tients who occurred with incipent chancres, in ten 
they were destroyed by immediate and effectual ap- 
plication of lunar caustic. Of the other ten, five 
were dressed with the blue mercurial ointment, and 
five with common wax ointment. The sores to 
which the caustic were applied, healed much sooner 
than the others, and next to these the sores that 
were dressed with mercurial ointment. Bat of the 
ten patients to whom caustic was applied, no less 
than eight had buboes, while only on£ bubo occurred 
in all the others, and it happened to one of the pa- 
tients whose chancre had been dressed with mercury." 
Mr Bell then relates the success of the same applica- 
tion where the patients had been previously saturat- 
ed with mercury. The success of it of course was 
much greater than that mentioned above ; still, how- 
ever, buboes were produced by it. 

In page 325, Mr Bell further observes, that " in 
most instances, buboes produced in this manner be- 
gin to form in the course of a day or two, after caus- 
tic has been applied ; in some cases even sooner." 
It is strange, after this, to find, that although Mr 
Bell informs us that he always uses mercury several 
days before the application of the caustic, he does 
not seem- to lay down any precautions in what he 
calls slight cases : indeed, throughout his book, he 
seems to treat them with escarotic washes from the 
commencement. We all know, that what may ap- 
u 2 



308 

pear to one a slight case, may to another be very se- 
rious ; of coarse, from this vague way of treating the 
subject, nothing can be learned, and much mischief 
may be wrought. 

One advantage, and that an important one too, 
which is derived from dressing chancres, or even 
other sores upon the penis, with the very mildest in- 
stead of the most irritating applications, is, that We 
shall be less in doubt, from such treatment, of soon 
ascertaining their real nature. Many sores on these 
parts, not at all venereal, have been treated as such, 
and long debilitating courses of mercury been given, 
without benefit, for their removal. Our want of a pro- 
per knowledge of the specific and invariable marks of 
a venereal chancre, has been partly the cause of this ; 
and partly the escarotic washes and other applica- 
tions given for its removal, which often irritated the 
sore, and made it worse. Simple dressings would 
have prevented one of these causes of deception, 
while the rapid spreading of the sore, till mercury 
was applied, Would have prevented the other; 

Mr Hunter, in page '140, very correctly observes, 
" In every case of chancre, let it be ever so slight, 
mercury should be given internally ; even in those 
cases where they were destroyed on their first ap- 
pearance. It should in all cases be given the whole 
time of the cure, and continue for some time after 
the chancres are healed ; for, as there are perhaps 
few chancres without absorption of matter, it be- 
~c6mes absolutely necessary to give mercury to act 
internally, in order to hinder the venereal disposi- 
tion from forming." 

Ointments of various kinds are by some applied to 
chancres, either that their emollient qualities may keep 
the sore soft andeasy,or that, by the absorption uf part 
of their active principle, such as is expected in the 
application of mercurial ointment, they will tend to 
the healing of the sore in the most effectual and safe 
way. 



309 

That ointments of different kinds are possessed of 
emollient qualities, no one will doubt; but that they 
are, from the hardness imparted to them by the wax 
of which they are formed, a good deal deprived of 
that quality, at least when compared with mild oil, 
is certain ; therefore, in respect to their comparative 
emollient qualities, there can be no similarity. That 
mercurial ointment thus applied, is totally useless as 
a specific, from the impossibility of its being absorb- 
ed in sufficient quantity, is too evident to require re- 
futation. To produce its beneficial effects, therefore, 
it must be applied more generally, and in greater 
quantity, Thus, not by its immediate action on 
the chancre, but by its general action on the system, 
it destroys the disposition to the support and propa- 
gation of venereal infection. 

When the parts around chancres inflame and 
swell, we must avoid all exertion or exercise likely 
to render them more so ; as, in such a state, unless 
attention be strictly paid to them, buboes will most 
likely be the consequence. With rest, therefore, 
while the mercurial course is persevered in, and the 
abstraction of blood by leeches, after which, the ap- 
plication of large poultices over the penis, is of the 
greatest benefit. 

Although, except from improper management, 
inflammation of the penis during the existence of 
chancres seldom becomes alarming, yet, in some in- 
stances, it does so, and requires not only general 
blood-letting, but blood repeatedly drawn from the 
part by leeches, and, after this, the free administra- 
tion of bark, to prevent mortification taking place. 

There are chancres which, from their first appear- 
ance, make uncommonly rapid progress. They are in 
general of a livid colour, assume a sloughing aspect, 
and are deep and irregular in their form. The pre- 
puce, too, is often hard and thickened, the glans red 
and hard, and a profuse and foetid discharge issues 
from the sebaceous glands, and the chancres dis- 
u 3 



310 

charge blood and dark-coloured matter. These must 
be treated with the greatest possible activity, as every 
circumstance connected with them demands our 
prompt and utmost exertion. A feverish state of 
the body not unusually attends this state, render- 
ing the patient's existence extremely irksome to him ; 
and this, till the system be affected by mercury, must 
go on. During the exhibition of mercury, then, in 
every possible way, both in the form of pill and oint- 
ment, the affected part ought to be frequently bathed 
with laudanum, or spirit of wine. Poultices too should 
be alternately made with oneor other of these liquids, 
to which may be added a proportion of bark or rheu- 
burb>and kept constantlyapplied to the affected parts. 
If the prepuce be enlarged to such a degree, as not to 
admit of being drawn back, so as to expose the ulcerat- 
ed parts to theaction of theseliquids or poultices, one 
or other of the liquids should be frequently thrown 
under the prepuce by means of a syringe. If we can- 
not arrest the progress of the disease, and from the 
above circumstance we cannot examine it, we ought 
at once to divide the prepuce, as we would in the 
cure for phymosis, so that a proper examination of 
the glans may be made. We at all times find, that 
under such rapidly encreasing forms of the disease, 
the laudanum or the spirit of wine greatly assists in 
preventing the progress of sphaculation, at least till 
the mercury affects the system, when it in general 
is arrested. 

In some cases, even during the most active treat- 
ment, this state of the parts has supervened, and part 
of the penis has dropt off, even in one or two days 
from the time this violent action of the parts began. 
When, under these circumstances, the large blood- 
vessels of the penis are corroded, the case is parti- 
cularly distressing, as, in such a state of the parts, 
the vessels cannot be secured by ligature ; we 
must therefore introduce a tube a sufficient length 



311 

into the urethra, and afterward apply pressure over 
the course of the ruptured vessel. 

When a chancre, however, shows some disposi- 
tion to heal, it is a common occurrence, particularly 
at every dressing, for it to bleed profusely. The 
contrary, as just stated, is the case in those chancres 
which penetrate to a considerable depth the body of 
the penis. In the first instance, the bleeding arises 
from the diseased parts having sloughed off, expos- 
ing the very minute blood vessels immediately under 
them ; in the latter, the bleeding takes place from 
the extensive ulcerations destroying the larger bran 
ches of the blood-vessels of those parts. 1 have, in 
two cases of the last mentioned sort, been absolutely 
under the necessity of inclosing a part of the caver- 
nous portion of the penis in a ligature, the bleeding 
vessel having shrunk into its substance so far, that 
without this I could not seize it. 

The cure of chancres is similar in both sexes; on- 
ly, as the dressings in women can with greater difficul- 
ty be secured, the necessity for washing the parts 
more frequently, is even more necessary in the for- 
mer than in the latter. 

Phymosis and Paraphimosis. 

Our treatment both of phymosis and paraphymosis 
are in most instances similar. In slight cases warm 
emollient applications, ointments, oils, &c. often ef- 
fect a cure. When the parts are somewhat relax- 
ed by these means, we must, in phymosis, be very 
cautious in drawing back the prepuce, lest it should 
thus be converted into paraphymosis. But in bringing 
forward the pressure in paraphymosis, we have no 
reason to apprehend so much risk. When these dis- 
eases become more complicated, when in phymosis 
there are chancres or adhesions underneath the pre- 
puce, and when emollient applications have but little 
or no effect in relieving the stricture, we must lay 
U4 



312 

it open in one or more parts according to the inve- 
teracy of the affection ; and where paraphymosis is 
so violent, as in a great measure to stop the circula- 
tion of blood in the penis, and thereby induce mor- 
tification, we must lose no time in relieving the stric- 
tured portion by dividing it. M- 

The best parts to make these incisions are along 
the sides of the penis; but, unless the urgency of the 
symptoms require it, we ought first to endeavour, by 
every kind of external application, and even bleeding 
at the arm, to moderate any violent degree of inflam- 
mation that may exist previous to our performing 
these operations. The instruments I use for both 
these purposes, are a small sharp-pointed knife gen- 
tly curved, or a pair of very sharp slender scissars. 
The knife, in phymosis, is introduced under the pre- 
puce ; its point thrust through it exactly at the spot 
which vye wish to make the extent of. our incision ; 
and it is then drawn forward with sufficient force to 
cut the intervening parts. If the scissars be prefer- 
red, one side of them is introduced under the pre- 
puce, and, by their blades being brought together, 
the intervening parts are cut. The parts are then to 
be kept from adhering by the introduction of a ple- 
git of lint between the prepuce and glans. The same 
instrument may be used in the removal of paraphy- 
mosis, by the point of one or the other of them be- 
ing introduced quite under the strictured part, which 
may thus be divided. In both operations, the parts 
should be allowed to bleed freely. 

When chancres are accompanied by phymosis, we 
piust be careful to prevent adhesions between the 
glans and prepuce. This may be done either by fre- 
quently and slightly moving the prepuce on the glans, 
by washing the parts with milk and water by means 
or a syringe, or by frequently introducing a probe or 
bougie between the prepuce and glans, and by run- 
ning it all round destroying any adhesions which 
may have formed. 



S13 

When phymosis has continued very violently for 
a considerable length of time, less or more of the pre- 
puce sometimes assumes a sort of cartilaginous con- 
sistence. In these cases, several of which have come 
under my observation, I have found that the com- 
mon operation, by incision, for the removal of the 
phymosis, has no effect; the parts thus diseased must 
be entirely removed, and great care taken to prevent 
the cicatrix from again contracting, and again form- 
ing the disease. 

When paraphymosis is not very severe, several 
small cuts being made in the longitudinal direction 
of the penis, all round the strictured parts, often 
enables us to bring -the prepuce to its natural situa- 
tion. But this is only losing time in severer cases. 

When otherwise, the proper operation mustbe per- 
formed; the prepuce may then either be brought over 
theglans, provided the chancres, if they do exist, are 
not very bad ; but if this objection be present, or if 
there be any likelihood of phymosis being afterward 
formed, it will be preferable only to perform the ope- 
ration, and allow the prepuce to remain where it 
was till the cure of all the symptoms be completed. 

In cases where the prepuce becomes distended 
with a sort of watery fluid, if the affection be slight, 
puncturing it with a broad shouldered lancet, and 
then the application of pressure, sometimes removes 
it. In this state, too, soaking the parts in strong 
ardent spirits of any sort, is of great service. But 
when this treatment does not succeed, we ought not 
to lose time, owing to the disposition of the parts to 
assume a cartilaginous consistence, but ought to per- 
form the common operation for phymosis. Even, I 
believe, under these circumstances, the entire re- 
moval of the prepuce, is the most adviseable practice, 
particularly if, from the other means, it has been re- 
moved, and shows a disposition to recur. 



314 



Bubo. 



In addition to the chances a patient runs of hav- 
ing buboes produced in consequence of the applica- 
tion of escarotic substances to the chancres, he, in 
dread of this affection, frequently applies pressure 
with his fingers to one or both groins, to ascertain if 
swelling of the glands there exists. By these means 
he almost invariably produces a bubo, which, but for 
the habit of applying such pressure to the common 
site of them, he might have entirely avoided. 

On the very first appearance of buboes, we ought 
in every case to use the most active means for their 
discussion. The system ought not only to be fully 
charged with mercury, but leeches and cooling ap- 
plications ought instantly to be applied for this pur- 
pose to the affected part. When, by a continuance 
of this practice, we reduce the bubo, though perhaps 
scarcely to its natural size, and entirely remove the 
pain formerly attending it, we have, so far as it con- 
stituted the disease, effected our purpose. 

The application of leeches, so indispensibly neces- 
sary for this purpose, seem to have been entirely, or 
almost entirely neglected, even by the most respec- 
table authors who have written on venereal com- 
plaints. Under such a want, I am not at all asto- 
nished at the greater proportion of buboes, even in- 
dependently of the strictest attention to the admini- 
stration of mercury, proceeding to suppuration ; and 
while an open, extensive, and generally ill-condition- 
ed sore is thus unnecessarily occasioned, the defor- 
mity which the part is subjected to, during every 
after period of life, is extremely unpleasant. 

In most cases of bubo, the patient, if other- 
wise convenient for him, may rub in the ointment 
himself; but if the bubo be very painful, or likely 
to suppurate, independently of every exertion we 
can make to prevent it, the patient ought not, on 

' //r 
/2 <v /// 04 €T*. 



i 






315 

any account) to use the exertion necessary for rub- 
bing in the ointment. In such cases, he ought to 
employ some other person to do this for him. 

To guard such person against suffering from its 
effects, his hand, during the operation, should be 
covered with the bladder of some animal. I am con- 
vinced that many buboes suppurate, when the patient 
uses the exertion of rubbing in the ointment himself, 
which) had any other person done it, might have 
been discussed. 

The custom, not yet by some dismissed from prac- 
tice, of rubbing mercurial ointment immediately on 
the surface of the bubo, is extremely prejudicial. 
They reason, that the absorption thus caused into 
the very part affected must resolve the tumor ; but 
they overlook the very bad effects of the mechanical 
irritation thus produced on the part already inflamed, 
which, in almost every case where it is adopted, in- 
dependently of any little absorption that may take 
place, terminates in suppuration. 

When a bubo, while suppurating, produces no 
great degree of pain, and when, independently of 
every attempt to discuss it, it proceeds to that state, 
we perhaps act a preferable part by allowing it to 
burst. But if, on the contrary, the pain be very 
great, the matter deep seated, and not likely soon 
to arrive at the surface, we will be justified in lay- 
ing it open. It has been observed, that buboes, 
when opened, do not heal so kindly as when allow- 
ed to burst of themselves ; we must, therefore, com- 
pare the advantages with the existing circumstan- 
ces, and either open them, or allow them to burst, 
as these circumstances seem most urgent. 

Unless the pain in bubo be very great, perhaps, 
by the application of warm poultices, it is prefer- 
able to allow it to burst of itself, the skin then be- 
ing thin, and in a great measure insensible, we can, 
without occasioning much pain, enlarge our inci- 
sion to any necessary extent. But if the pain be 



310 

great, we ought, when we can distinctly feel the 
fluctuation of matter in it, to lay it open with a lan- 
cet or sharp pointed bistoury, or with caustic. I 
myself prefer the former, as it is more quickly done, 
and there is-, in that way, no unnecessary loss of parts. 
These operations, however, must be greatly regu- 
lated by the timidity or strength of mind of the 
patient. 

When it is found necessary to open a bubo by 
either of the methods now mentioned, the termi- 
nation of our incision, to prevent collections of mat- 
ter, ought always to extend to the most depending 
part of the tumor. For several days, till the irri- 
tation occasioned by the operation has, in some de- 
gree, subsided, the sore ought to be washed with 
milk and water, or some other mild liquid, by means 
of a syringe; and as the parts sometimes become 
indolent, it will be necessary to inject into it a 
quantity of diluted laudanum, or even laudanum by 
itself, or to dress the sores with strong stimulating 
ointment. This treatment generally hastens the 
cure very remarkably. 

When a bubo either bursts, or is opened by any 
instrument, it usually assumes a healthy appear- 
ance in the course of a week or two, and granula- 
tions spring up from the whole ulcerated surface, 
and terminate when they arrive at the surface, on 
a level with the healthy skin. But in some cases, 
particularly in weakly or scrofulous habits, the sores, 
instead of assuming the wished- for healthy appear- 
ance, become of a purple colour, with inverted or 
thickened edges, sinuses of various depth and ex- 
tent are formed, and instances are on record where 
no sort of attention could arrest such ravages, and 
the patient became hectic and died. 

There is a state of irritation which in some ha- 
bits, (not unfrequently in such as have now been 
alluded to), continues after a bubo has been opened, 



317 

and often occasions extreme distress to the patient, 
depriving him even of his natural rest. In such 
cases, opiates internally, and laudanum externally, 
are of great service. Laudanum thus externally 
applied,, occasions at first considerable pain ; but 
that soon ceases ; and the comfort afterwards experi- 
enced from this application, will make even the 
most timorous willing to submit to it. In addition 
to these, or rather in milder cases, they are most 
successfully treated with warm poultices. For this 
purpose, bread and water boiled is very good, but 
turnips, or, in preference to that, carrots made into 
a poultice, answers our purpose well. The irri- 
tation soon abates, and the matter which, during 
that irritable state, was .thin and of a brown colour, 
is soon changed to a more healthy appearance, and 
the sore rapidly heals. 

Sometimes, when a bubo has nearly healed, it 
continues stationary, and a trifling sore of this 
kind will remain for weeks or even months, which, 
as it is not particularly distressing to the patient, he 
is apt to overlook. VVhen, however, this is not re- 
moved, it often, in process of time, assumes a more 
unpleasant appearance, which may, at all times, be 
prevented by the application of any caustic sub- 
stance to it once every two or three days for a week 
or two. But in those extensive ulcers which suc- 
ceed to buboes, when we are convinced that the 
venereal virus has been entirely removed from the 
system, I never find any difficulty in curing them, 
by a method, I uniformly find successful in the cure 
of ulcers in general ; viz. by the internal use of 
cantharides. 

In those indolent buboes, which, in particular 
states of constitution, are to be met with in prac- 
tice, and which are so perplexing to the medical at- 
tendant and" tedious to the patient, no generally 
understood plan of treatment seems to be iollowed. 
In consequence of this, I have known one of these, 



318 



even without occasioning much pain to the patient, 
swell to an amazing size. Independently of the 
most rigourous application of mercury, in every 
form, both externally and internally applied, I have 
known them remain for many months, without ei- 
ther suffering the slightest diminution in their size, 
or seeming disposition to proceed to suppuration. 
During the application of these remedies, the 
strength of the patient sunk very rapidly, and I have 
no hesitation in saying, that, by obstinately perse- 
vering in this way, the most robust constitutions 
have been at length irreparably ruined. By this 
sort of treatment, I have known them break, by a 
very small opening, and a clear watery matter dis- 
charged, without any reduction of the size of the 
bubo, which proved for many months extremely 
distressing. 

The treatment I have found most decidedly use- 
ful, under these circumstances, was, by slightly af- 
fecting the system by some of the preparations of 
mercury, and by the repeated application of blisters 
to the part, perhaps one every three days, with 
the application of a warm poultice, from time to 
time, either reduced them entirely, or speedily 
brought them to a state of suppuration. In other 
instances, I have found the alternate application of 
a sinapism and warm poultice, repeated for several 
days, answer a similar purpose. 

All sympathetic buboes, appearing during the 
existence of chancre, &c. ought, for the safety of 
the patient, to be treated as venereal. If in this 
plan we err, we do it on the safe side ; for certain- 
ly there can be no comparison between the bad 
effects arising from a course of mercury unnecessari- 
ly taken, and the dreadful consequences of having, 
by other means, only destroyed the disease in ap- 
pearance, while its violence in the system remained 
unsubdued, and ready at every future period to 



319 

break forth on some part or other with redoubled 
violence. 

In advanced cases of this disease, one or both 
testicles sometimes swell very considerably. In 
some instances, they even become schirrous, the 
spermatic chord is thickened, and the scrotum 
breaks out into various ill-conditioned ulcers. 

Eruptions, Ulcers, &c. 

The common and pernicious custom, of believ- 
ing that the longer diseases remain in the system, 
they tend to their own destruction, has been car- 
ried to a great height in respect to lues venerea. 
I once adopted this opinion, in common with others; 
but, from the frequent disappointments I met with 
in attempting to imitate authors, by curing secon- 
dary symptoms in one, two, or three weeks, accord- 
ing to their statements, I was compelled at length 
to doubt the possibility of it. From actual obser- 
vation, I am now of a directly contrary opinion ; 
conceiving that, in the generality of cases, the long- 
er the disease continues in the system, and the more 
extensive its ravages are, the more difficult and the 
more tedious it is to effect a cure. There may be 
some exceptions to this, but these cannot establish 
a general practical doctrine. 

I think there can be no doubt, that the venereal 
virus may often be completely destroyed, although 
the blotches or ulcers caused by it remain seeming- 
ly as before. In these affections, then, it is not al- 
ways necessary to continue the mercurial course till 
they are perfectly heal ; yet, from our want of a pre- 
cise knowledge of certain appearances which proba- 
bly are peculiar to venereal ulcers, we are, in many 
instances, at a loss in this particular part of our 
practice. We must, therefore, be greatly influen- 
ced in our proceedings by the general health of the 
patient in other respects, the changes the ulcers 



320 

have undergone during the use of the mercury, and 
the length of time the patient has continued under 
the course. With regard to their not being great- 
ly altered in their appearance, we know, that in- 
durated or scirrhus glands, nodes, &c. from a ve- 
nereal cause, often remain for life as large as before 
the exhibition of mercury, and yet are perfectly 
harmless. 

It ought to be particularly attended to, that the 
eruptions and blotches which appear from a venere- 
al cause, are certainly different in appearance as 
well as situation. But when we have ascertained 
their existence to depend on such a cause, which, 
from our present state of knowledge, is not easily 
done, even from any appearance they may assume, 
our plan of treatment is attended with but little dif- 
ficulty. One or other preparation of mercury, ex- 
ternally or internally applied, according to existing 
circumstances, will almost always effect a complete 
cure. 

In the generality of venereal ulcers, constituting 
secondary symptoms, on whatever part of the body 
they may appear, it is commonly only necessary to 
impregnate the system well with mercury to effect 
their entire removal. But, independently of this, if 
they remain stationary and even become worse, pro- 
vided we are sure they are not caused by the mer- 
cury ; we must, to internal means* add external ap- 
plications, such as the various astringent washes and 
caustic substances ; and even the removal of some 
parts by the scalpel is often of the greatest benefit 
in hastening the cure. 

These appearances are apt, as in the case of some 
chancres, to assume a sort of action after the vene- 
real virus has left the system, which cannot, by any 
natural powers of the body, or even by these aided 
by internal medicines, be removed. In such cases, it 
is absolutely necessary to use the above substance. 

The first effect of mercury on a venereal ulcer, is 



321 

to render it somewhat cleaner. This, however, oc- 
curs at very different periods in different individiu 
als, but in all of them, when the parts have assume 
ed this state of action, the cure generally goes on 
very rapidly. 

In these sores, then, mercury must be pushed as 
long as they continue to heal under it, and even two 
or three weeks after they have entirely healed ; but 
if the healing process be arrested, we must instantly 
leave off the mercury, to prevent badly conditioned 
ulcers being formed. With such surgical aid as 
may be necessary, we then find that change of 
air, animal jellies, and as much nourishing food as 
the stomach can easily bear, must be substituted, 
with bark, wine, &c. and it is seldom if ever be 
necessary again to have recourse to mercury. 

It is a pity that medical mert should have paid so 
little attention to those changes which venereal sores 
undergo during the treatment adopted for their remo- 
val, though, in a practical point of view, it is of the 
utmost importance. From this circumstance alone, 
I am sure that many complaints, purely venereal, 
have been deemed otherwise ; and many, with not a 
vestige of that disease about them, have been treat- 
ed on the principle that the venereal virus still ex- 
isted in the system. At an early period of my life, 
before practical knowledge had entitled me to judge 
of these matters, I witnessed a case of the last de- 
cription, for the success of which I felt myself deep- 
ly concerned. The gentleman I allude to, had 
been in the habit of using mercury almost constant- 
ly for about two years. At the end of that period, 
he again found it necessary to have recourse to the 
same medicine. The state of his complaints, at this 
time, were in the form of chancres and buboes ; he 
had within the two preceding years been affected 
with ulcerated throat, nodes on the bones, &c. For 
the removal of the chancres and buboes, he now 
used mercury externally and internally, with co©;U 
X 



322 

!ng applications and leeches to his groin. They 
gave momentary relief, but his former symptoms of 
sore throat, nodes, &-c. recurred; he persevered in 
the use of a variety of the preparations of mercury, 
till, at the end of six months from the attack of the 
last symptoms of his complaints, he could take, 
without more than slightly affecting his mouth ; 
twelve mercurial pills daily, and use by friction 
nearly an ounce of the strongest mercurial oint- 
ment. He still continued to encrease the quantity 
of his medicine, which he was induced to do, from 
having consulted those medical men who at the 
time were deemed the most celebrated in that line 
of practice in Edinburgh. In six months more he 
was emaciated to a great degree, and had then ad- 
vanced the doses of the mercury to eighteen pills 
daily, and also used one ounce and a-half of the 
strongest mercurial ointment. His medical men at 
length entirely deserted him, unless from time to 
time to call and desire him to continue the mercu- 
ry, and he would certainly get well at last. Indeed, 
at that time he was disposed to think them right ; 
for if he at any time attempted to diminish the doses 
of mercury, all his sores became worse. He at length, 
in a state of mind almost approaching to despair, de- 
termined entirely to give over the use of the mercu- 
ry, as he now thought his complaints incurable. 
He did so, and to quiet the perturbation of his mind, 
he also determined to enjoy all the comforts to be de- 
rived from the liberal use of wine. By gradually 
increasing the quantity, he drank about two bottles 
of port wine daily, yet his sores became worse, as- 
sumed a black colour, and a foetid discharge issued 
from them. Still, however, he determined never to 
have recourse to mercury. In this state, then, he 
continued about six weeks, during which time he 
was at least one half of the day in a state of intoxi- 
cation, partly from the weak state of his body, but 
principally from the quantity of wine he drank. His 



323 

sores then assumed a more favourable appearance* 
and in two weeks more they were evidently mend- 
ing. This gave him some encouragement, and he 
began to use daily about half an ounce of Peruvian 
bark in addition to the wine ; and, without the use 
of any other medicine, he entirely recovered in a few 
months. It is now several years since this occurred* 
and he has never had any attack of that disease in 
any form. 

Sore Throat. 

When mercury affects the mouth violently, any 
of the acids diluted may be used with advantage as 
a gargle or wash. Tinctura opii may also be used, 
When diluted with water, with good effect, particu- 
larly when the parts have become uneasy, rather from 
irritation than from any violently inflammatory state. 
Any of the astringent gums, in the form of solution, 
or a decoction of astringent barks, may also be used 
perhaps in preference to either of the above. 

It has been asserted, that muriate of mercury, 
given when the disease affects the mouth or throat, 
acts on it in the manner of a gargle, and is apt to 
heal the sores before the disease for which it was ad- 
ministered is destroyed. How far this reasoning 
may apply, when it is given in the form of solution, 
I will not pretend to determine ; but certainly, when 
given in the form of pills, it cannot act as a gargle 
on parts which it scarcely ever touches ; and. in this 
form, occasionally* in combination with a small pro- 
portion of opium, I have often given it with the 
most decided advantage. 

Although, however, in the milder secondary 
symptoms, such as slight inflammation of the throat, 
and copper-coloured spots on the skin, I have found 
the cautious and properly regulated administration 
of muriate of mercury fully sufficient to effect the 
cure ; yet, in the deeper seated affections of this sort, 
X 2 



324 

such as disease of the bones, &c. I have uniformly 
found that, in addition to it, friction with the blue 
mercurial ointment over the affected parts, always 
caused a more speedy cure than when this last ap- 
plication was omitted. 

We sometimes find, from bad teeth, or previous 
affection of the gums, that during a course of mer- 
cury, even conducted in the most careful manner, 
the inflammation spreads backward toward the fau- 
ces, and this sometimes leads an unexperienced 
practitioner into a belief that this inflammatory af- 
fection is caused by the disease, not by the mercury, 
and thus, along with disappointment to himself, 
much unnecessary trouble is caused to the patient. 

When the throat has been thoroughly affected by 
the venereal disease, we may be certainly assured 
that it will never heal of itself, or by any power 
which the system possesses in throwing off the af- 
fection which caused it. 

In an affection of this kind, we sometimes find 
the glands about the throat indurated. From such 
a state we seldom reduce them to their original 
condition. But it is fortunate that the disease 
which caused such an appearance, may be com- 
pletely removed, even if the swelling should remain 
undiminished. 

Bones. 

Mercury, when applied for the removal of a ge- 
nerally infected constitution, often recovers the mor- 
bid state of the soft parts, by which state they heal, 
while the disease remains unchecked in the more solid 
parts, such as the bones. Mercury, therefore, is of- 
ten discontinued, when the soft parts heal ; while the 
disease not being removed from the bones, but on- 
ly blunted in its violence, soon recovers its for- 
mer virulent state, which demands the most serious 
attention. 



325 

The tendons also are sometimes venereally affect- 
ed and enlarged ; but they may be inflamed and en- 
larged from other causes. The true state of such 
parts is best known during the cure, for if the symp- 
toms be venereal, they will yield only under a 
course of mercury, while, if otherways, they may 
be removed by other means. If venereal, too, they 
never abate for any length of time ; but if they arise 
from rheumatism, gout, &c. they may even subside 
of themselves. 

Provided, then, we are certain that nodes are the ef- 
fect oflues, they are only to be cured by the same ge- 
neral means, (mercury, with the occasional use of 
decoctions of the woods, he.) The pain in them 
being often very great, it is necessary to apply re- 
peated blisters over the whole surface, or leeches to 
the affected part ; or we may make an incision down 
to the bone, and extending the whole length of the 
tumour. But this last step must be done with the \ 
utmost caution, as the performance of such an ope- „' 
ration, unless unavoidable, may lead to troublesome \Vi 
consequences. If the bone has become carious, the y 
original disease ought to be destroyed before we at- Vr* 
tempt exfoliation of the diseased parts of it, when \i 
it may be done with greater ease and more safety. .„, 

During the existence of nodes, then, on various 
parts, we find that mercury, taken internally, and 
applied externally, will in general remove them. 
The same observation may apply to thickening of 
the ligaments or fascia, from a similar cause. In 
many cases the parts affected are greatly swelled, 
and the pain attending it, probably caused by this 
state, is excruciating. The bone has been suppos- 
ed to be carious, when only an enlargement of it 
and its surrounding parts existed ; caustic has, in 
this state of it, been applied over the affected part, 
the periosteum was thus destroyed, and the bone 
laid bare. Thus an exfoliation, although no caries 
formerly existed, will take place, and therefore, un- 
x3 



326 

less inflammation or actual ulceration of the part 
occurs, no caustic should be applied. 

In such cases, the application of leeches alone, or 
a blister applied over the affected parts, while the 
mercury is continued, is productive of the most 
happy effects. When this treatment is not success- 
ful, suppuration, though slow, and attended with 
acute pain, is generally the consequence, and the 
matter is not like healthy pus, but of a slimy na- 
ture. 

While the disease in the bones has spared enough 
of the living principle by which they can support 
themselves, they are, with scarcely any exception, 
curable by mercury ; but where the bone is entire- 
ly destroyed, no treatment, however judicious, can 
be of any service. In the first instance, the mercury 
produces a favourable change in the feelings of the 
patient, which always proves that a continuance in 
its use will effect a cure. But in the latter, mer- 
cury produces no alteration of the symptoms. If 
the skin be sound, we should at all times allow the 
constitution to be fully affected by the mercury, 
which, from its beneficial effects, would prevent 
many a harsh and cruel operation. 

Even after the venereal taint has been removed, 
the diseased portions of bone act as a foreign bodies, 
and the ulcerated parts can only recover upon the se- 
paration of them from the sound. This may be pro- 
moted ; if the diseased bone be in the mouth, it may 
be washed and kept clean with mild liquors, and if in 
the ears, they may be syringed with some similar li- 
quids. Exfoliations of this nature are greatly acce- 
lerated by restoring the state of general health, and 
the rapidity with which the ulcers heal, after this 
has been effected, is astonishing. 

Sometimes after a cure, enlarged bones return to 
their original size, but more commonly they remain 
always enlarged at that part. 



A 



327 
Opthalmia. 

Venereal opthalnaia should, with the addition 
of the exhibition of mercury, be treated as opthal- 
mia from any other cause. Vitriolic and astringent 
washes are, in general, beneficial, and if the vessels 
be much distended, they ought to be divided. But 
in scrofulous patients, as I have elsewhere had occa- 
sion to remark, opthalmia, from this as well as from 
any other cause, must be treated very differently. 
Spirits of wine or laudanum must be daily blown in- 
to the affected eye through a small quill, or oint- 
ment of a stimulating nature must be daily introdu- 
ced within the eye-lashes. A division of the ves- 
sels, too, in this state of disease, is often necessary 
in scrofulous, as well as in those patients of another 
habit of body. The various vitriolic solutions, 
which are often useful in the cure of such affec- 
tions in the generality of patients, are decidedly 
bad in patients of a scrofulous habit. / 

Blindness, Deafness, &c* 

When either blindness or deafness affect a per- 
son from a venereal cause, the case is in general of 
a very hopeless nature. Still, in a slight affection 
mercury may sometimes be used with considerable 
advantage ; but, when the coats or humours of the 
eye are greatly diseased, or when the bones of the 
internal ear and eustachian tube are considerably af- 
fected, very little benefit, I am sorry to say, is in 
general obtained from our utmost exertions ; yet 
still, even under these circumstances, while the con- 
stitution is not materially affected by mercury, we 
ought to continue it, as whatever benefit we may 
reap must principally be derived from this remedy. 

From this disease, or even from its remedies, there 
sometimes occur, in addition to the above, very 
x4 



328 

dreadful symptoms, such as falling off of the hair 
and eye-brows, seemingly rheumatic pains, dropping 
out of the teeth ; the nails become curved, and 
sometimes fall off. In short, every part of the bo- 
dy becomes affected, rendering the whole system 
one loathsome mass of contamination. Yet I am 
firmly persuaded, that, not only from the disease, 
but from an injudicious or from a too long conti- 
nued course of mercury, all these and many more 
symptoms may arise. This is an addititional proof 
of the necessity there is for a medical man being 
aware of every appearance the disease can assume, 
and of the bad as well as of the good effects of the 
remedies prescribed for its removal. 

Warts, &c. 

In whatever form lues venerea may appear, it 
may only require the administration of mercury for 
its removal ; or it may be found necessary to employ, 
either along with that medicine, or after it, such sur- 
gical assistance as will be necessary and proper to 
prevent there being formed a distinct disease, even 
after the venereal affection has been completely sub- 
dued. Thus we find, that not only fungous excrescen- 
ces, but, as formerly stated, rugged sinuous indurated 
ulcers, carious bones, diseased glands, &c. all of 
which and perhaps the most simple is that of warts, 
must often require chirurgical aid. 

Warty excrescences, then, with unequal cauli- 
flower-like surfaces, and pendulous long- necked 
productions, like polypi, are frequently to be met 
with in the labia of women, and on the glans, and 
still more frequently on the prepuce of men Their 
origin seems superficial, and they are most com- 
monly to be met w,ith immediately after the remo- 
val of chancre, bat they scarcely ever.exist from a 
venereal taint remaining in the system. Their de- 
struction, therefore, is in general easily affected, by 



32g 

first removing those of a pendulous form with the 
knife or ligature, and afterwards inducing inflamma- 
tion in the parts, by the application of escarotic sub- 
stances, while those of a broad base may, with- 
out a ligature or knife, be removed by any of the 
caustic substances in common use, either in a li- 
quid or in a solid form. They also may be com- 
pletely removed by the daily application of the pow- 
der of sabinae applied to the affected parts. 

I think, when we are at all doubtful respecting 
the real nature of warty or other excrescences 
which sometimes appear about the anus, at one or 
other period during the existence, or even after lues 
venerea has disappeared, it is safe enough to treat 
them by the application of escarotics, ligatures, &c. 
as if unconnected with that affection. But if, from 
their frequent recurrence after such plans have been 
duly attended to, we have reason to believe them of 
a venereal nature, recourse ought instantly to be 
had to the use of mercury in addition to the above. 
By these means, they will consequently lose their 
venereal nature, which may be known by their ceas- 
ing to return. />U^^w « fit* *&> 

Mistaken for other "Diseases. 

If venereal pains be mistaken for rheumatism, 
gout, &c. which not unfrequently happens, and 
treated as such, the patient cannot, under such re- 
gimen, experience more than partial and momen- 
tary relief; for his disease will gain ground, and 
the symptoms at length become more aggravated, 
till another and more permanently effectual method 
of treating it be adopted. 

We not unfrequently find that lues rages in the 
system with considerable malignity, especially when 
it affects the bones, while the patient remains uncon- 
scious of his real situation. One day it is thought to be 
rheumatism, another the gout ; and the materia me- 



r / 



330 

dfca is ransacked for remedies to relieve these symp- 
toms, but, as may be imagined, without effect. It 
is at length conceived to be lues venerea, but not 
till the haggard and emaciated frame is too weak to 
bear the debilitating effects of a course of mercury, 
I have known many vigorous young men from 
this cause reduced to a state of the most deplorable 
wretchedness. We therefore cannot too strongly 
inculcate the propriety of the very utmost attention 
being paid to the recurrence of these symptoms, and 
if it has a similarity to any venereal complaint, and 
especially if it has withstood other remedies, we 
ought not to delay the application of such means as 
will make a perfect cure, till the debility of the ge- 
neral system prevent their administration. 

Impropriety of the application of certain substances 
to Venereal Chancres, &c. 

I have already frequently insisted on the impro- 
priety of certain substances being applied for the 
cure of chancres. I shall now do it more in detail. 
The very attempt, then, Jjojieal, by escarotic appli- 
cations, a sore which we^some reason to believe is 
a chancre, is at least fraught with the greatest risk, 
if not perhaps with danger. We know that, as in 
small pox, the minuteness of the fluid which is 
fully sufficient to infect the whole body, is incon- 
ceivably small, and undoubtedly, as in that instance, 
lues venerea affects the system with considerable ra- 
pidity. We, therefore, have good reason to be- 
lieve that such a substance as caustic, immedi- 
ately applied to the infected spot, may heal it exter- 
nally, though it produce no effect on the disease, 
which has thus already made its way into the sys- 
tem. And certainly, considering the comparatively 
trifling harm which a well managed course of mer- 
cury, for probably not more than three weeks at 
most, will produce, no reasonable being should ever 



331 

run the risk of burying such a tremendous disease 
in the system, to break out at any future period, 
when by this it can be safely prevented. 

In support of the propriety of applying external 
escarotics, &c. during a course of mercury, it has 
been stated, that mercury without them always ef- 
fects the cure in a more tedious manner than when 
its use is accompanied by these external means ; 
and that, in some patients, although administer- 
ed for many weeks, it entirely fails of healing them 
without such applications. I readily grant that chan- 
cres may, in general, be more speedily healed, when 
external escarotics are applied, than without them ; 
yet we can by no means be satisfied, under these 
circumstances, that we have cured the disease, but 
twenty to one we have, as just observed, locked it 
up in the system. I should wish to know from those 
who support such opinions, and who consequently 
practise upon them, what the particular nature of 
the action of external applications is, in entirely 
eradicating the venereal virus. Mr B. Bell informs 
us, in p. 318 of his second volume on venereal com- 
plaints, that " the internal exhibition of mercury a- 
lone will not always cure chancres. I have known," 
says he, " a person kept under the complete effect 
of mercury for many weeks, and the chancres for 
which it was prescribed remain nearly in the same 
state as at first ; nay, in different instances where 
this practice was pursued, and in which the cure 
was trusted to mercury alone, although the remedy- 
was continued in all of them for six or seven weeks, 
and under the best management, as the chancres 
did not heal, the mercury was laid aside, on the 
supposition of the constitution being rendered safe; 
but although in all of them the sores were soon cu- 
red by the application of caustic, red precipitate, 
or some other escarotic, in several, symptoms of 
pox appeared in the course of a few weeks ; in some 
with ulcers in the throat, and in others with blot- 



fo 

% 



332 

ches on the skin." Such cases must have occurred 
in every one's practice, extensively connected with 
that branch of the profession, but surely we can ne- 
ver build a general and infallible doctrine upon them. 
Besides, in these cases, the chancres had assumed 
that sort of diseased action which, before they could 
heal, rendered the destruction of that state of di- 
sease absolutely necessary. It is evident that the 
escarotic application possessed no other effect on 
these chancres, but merely the destruction of its 
edges or other parts, which was absolutely neces- 
sary before it could heal. Had it done any thing 
else, why did the disease recur, as mentioned by 
Mr Bell ? It is then very plain in the above rare 
occurrence, that, by a little longer perseverance in 
the use of mercury, and when the inflammatory dis- 
position of the chancre had been in some measure 
removed, so that such application did not run any 
risk of occasioning buboes, the combination of mer- 
cury internally, with the external application of 
caustic substances, would have at length entirely 
completed the cure. But I must repeat, that, from 
such occasional occurrences, we must not, unless 
we expect to work much mischief, form any gene- 
ral rule of practice. The application of caustic sub- 
stances in chancre is at all times uncertain, and of- 
ten hazardous, and must never be generally used, but 
^ when, from certain changes in their appearance, the 
medical attendant judges them necessary and proper. 

If ulcers, again, we know not on what account, 
after having assumed a healthy appearance, become 
worse and spread farther, we may rest assured that 
the venereal disease does not now prevail in the sys- 
tem ; but that these sores arise from some other 
cause which will not likely yield even to the most 
judicious use of mercury. 

Every appearance, also, produced by venereal virus 
may exist after their cause has been removed. It is, in 
such instances, either caused by primary or seconda- 
ry symptoms, that external astringents or escarotics 



333 

are principally useful. The experience and judgment 
of the medical attendant here has its most decisive 
trial, and, according as the result of his opinions 
and practice are attended with success or other- 
wise, his judgment is to be valued and preferred to 
others of the same profession. This, indeed, is the 
standard by which all professional men ought to be 
judged ; and reputation, instead of being bequeathed 
from father to son, and from master to apprentice, 
which is often the case, ought only to be the reward 
of industry, of perseverance, and of success. 

No occupation, profession, or any thing else, 
ought to prevent us devoting all our attention to the 
removal of this disease, however slight, the moment 
we have ascertained that we are affected by it. The 
many instances of its having disappeared when in the 
form of chancre, from external applications, yet still 
remainingfor years in the system, without apparently 
producing any material alteration, till it broke out 
with all the dreadful and often destructive appear- 
ances peculiar to secondary symptoms, ought to be 
esteemed powerful inducements in making us de- 
vote all our attention to its entire removal when in 
a more simple form. 

Cleanliness. 

In the treatment of every species of venereal com- 
plaints, cleanliness is our first object, and a strict ob- 
servance of it ought to be maintained throughout 
the cure. Without this, we have not only to bear 
with the filthiness which naturally arises from such 
complaints ; but it has been believed, that the absorp- 
tion of matter which on such occasions must take 
place, greatly aggravates the very disease for the re- 
moval of which our other remedies are applied. 



334 



Modes of Living. 

Independently of the great difference which na- 
turally exists in the absorbent system of some pa- 
tients, rendering a larger quantity of mercury, in 
whatever way applied, absolutely necessary than in 
others, for the removal of lues venerea, we find a 
similar peculiarity exist from artificial causes. Thus, 
certain irregular modes of living, which debilitate 
the body in general, tend also to render the absor- 
bent vessels very inert ; and large or inconsiderately 
applied doses of mercury and several other medicines 
produce similar effects. 

I believe intemperance, during a course of mer- 
cury , to be the great cause of all the mischief which 
generally attends such astate. Thehabitsofsuch per- 
sons as are frequently affected with these complaints, 
being very often of an irregular nature, not during 
one, but for a succession of days, oblige them at 
length to retire to their chambers, and be more rigid- 
ly correct in their conduct than would have been ne- 
cessary, had they, at an earlier period, attended 
more strictly to rules of regularity. 

I have uniformly observed, that during the exhi- 
bition of mercury the use of spirituous liquors in 
particular, except in very small quantity indeed, is 
extremely improper. The effect produced by the 
spirit does not at all seem to prevent the mercury 
from acting on the mouth ; but the disease, during 
its use, is seldom arrested in its progress, at least 
for many weeks, or even months after it should have 
been cured. In many such instances, even while 
the mouth remains sore, the symptoms of the disease, 
instead of being removed, become much worse. By at- 
tention to this circumstance alone, I have at first been 
prevented from curing many cases which, on these 
matters being regulated, have at length yielded with 
the utmost ease. 



335 

In the treatment of every such complaint, then, 
we will find that a temperate patient will be easiest 
cured, and run fewest chances of being afterward 
affected by secondary symptoms. But one of oppo- 
site habits will not only preserve the disease long 
about him, but the chances of its lurking in the sys- 
tem, compared with the other, are numerous. It 
ought to be an established rule, that mercury should 
never have any other stimulus to strive with but the 
venereal virus. 

Woods, &c. 

Although I believe various decoctions of the woods 
incapable of entirely curing the venereal disease, yet 
they may possibly act as auxiliaries during the exhibi- 
tion of mercury ; at all events they can do no harm, 
and therefore may at all times, when otherwise agree- 
able, be used. For this purpose, the best of them 
are probably the decoctions of guaiacum of sasafras 
and of sarsaparilla. 

Although, then, I have no great faith in the indi- 
vidual power of any of the woods, nor even of the 
acids, in the removal of these complaints, yet I have 
seen decoctions of them, or the acids in a diluted 
form, taken in combination with mercury, of sin- 
gular service, when mercury itself seemed to produce 
no very remarkably beneficial effect. This I have 
observed more commonly in advanced cases than in 
recent ones. I may also mention, that when the 
mercury has debilitated the system greatly, but with- 
out completely eradicating the disease, the woods 
may be substituted for it till other means have been 
employed to prepare the system to be again subject- 
ed to the operations of mercury. During their use, 
the disease seems only checked, but not removed. 



336 



Preparations of Mercury. 

Among the whole list of medicines, which from 
time to time have been held forth to the world as 
possessed of antivenereal properties, none have stood 
the test of experience so effectually as the different 
preparations of mercury. From the generally ac- 
knowledged reputation of some, and the understood 
eminence of others, various materials have been pro- 
posed by medical writers, and have had the very 
fairest trials, but they have all, seemingly by general 
consent, in a great measure sunk, into disuse. 

It is extremely probable that the good effects of 
mercury, in the cure of venereal affections, was 
discovered by mere accident. For we read in the 
works of ancient authors of it being first applied for 
the cure of cutaneous eruptions in general. It is 
therefore very probable that it was in this indiscri- 
minate way applied to some venereal cases, and, from 
its good effects in removing them, became an esta- 
blished remedy. 

The different preparations of mercury, then, al- 
though no specific, from their having failed of suc- 
cess in some instances where they have had the 
fairest trial, are now universally acknowledged to be 
the only medium on which we can depend for gene- 
ral success. 

But while this medicine must be recognised as the 
most valuable with which we are at present ac- 
quainted, it is often, in the hands of the rash, the 
dull, or the inexperienced, productive of the most 
serious mischief. It is not from witnessing one or 
two instances that I have been able to make this 
statement, but from a host of cases, to which 1 have 
been called, where the patients had been reduced to 
the greatest possible degree of debility, seemingly in 
some of them almost irrecoverable; not so much 
from the effects of the disease, at least latterly, but 



337 

purely from the misapplication of the remedy ad- 
ministered for its removal. 

Being very early obliged, from the service in which 
I was then engaged, to dedicate much of my time to 
the practical part of my profession, and particularly, 
from certain circumstances, to the venereal depart- 
ment, I had occasion to try the the comparative ef- 
fects of the different preparations of mercury in every 
different stage of that disease, even before the then 
limited extent of my reading made me acquainted 
with the many discussions which have agitated the 
profession upon these points. 

In recent affections, the blue pill or ointment, or 
pills made from calomel, (submuriate of mercury) 
mere, cinereus, &c. are probably the best. Their effects 
in the removal of the disease in this stage may be 
depended on, and their action on the stomach and 
bowels is scarcely ever so violent as to cause alarm. 
But I have uniformly found the superior efficacy 
of the cautious use of the muriate of mercury, or 
corrosive sublimate, in far advanced or in secondary 
symptoms of lues, and much as I have read on the 
subject since, I have not yet seen cause to alter my 
opinion respecting the use of that medicine. 

I am aware that it is more apt than almost any 
other preparation of mercury, to affect the stomach 
and bowels, and it is, therefore, very necessary to 
pay much attention, not only to the doses, but to 
the form in which it is used. Forming pills of it 
with crumbs of bread is perhaps somewhat unsafe, 
as it is scarcely possible to levigate it so finely, and 
diffuse it sufficiently through the mass, as to prevent 
it acting on the stomach with much violence. But 
in the form of solution in water, which is afterward 
made into pills with bread, each containing one- 
eighth of a grain, is what I use with the greatest suc- 
cess. 

I have no wish to extol the superior efficacy of 
any particular preparation of mercury, and as is too 

Y 



338 

often the case, when the good effects of one parti- 
cular form of it in preference to all others is alone 
to be insisted in, overlooking all its bad effects and 
magnifying its beneficial properties. My object is 
the removal of the disease in the safest and most ef- 
fectual way for the patient ; and I hope that no spe- 
culative reasoning, however plausible, will ever have 
the smallest effect in altering my mind on that sub- 
ject, unless such reasoning has for its basis sound 
practical observation. 



Rules for the Administration of Mercury. 

Every body knows that it is from mercury alone, 
in one form or other, that we are to expect the com- 
plete removal of the venereal disease. But it requires 
time and experience to know in what manner, and 
and under what circumstances, it is or is not to be 
used, and what quantity will be necessary to produce 
the desired effect. Every patient possesses a state 
of constitution peculiar to himself, and even this va- 
ries in the same patient at different times. On this 
account, the same degree of morbid action may occa- 
sion the progress of his complaints to be more slow or 
rapid, mild or malignant, than what may be found in 
another. Under these circumstances, it must appear 
evident that no given quantity of mercury can be 
calculated upon for the relief of patients so diame- 
trically opposite in their constitution. We must, 
then, while we rely on the powers of the mercury, 
depend on our own judgment in the administration 
of it ; and it will be found that attentive unbiassed 
observation and experience will at all times be more 
successful than practice dictated by the most bril- 
liant imagination without these advantages. 

Were no peculiarities of constitution to exist, we 
could calculate to a mathematical certainty the pre- 



339 

cise quantity of mercury which would cure every 
venereal complaint. But experience must have 
taught every one how impossible it is to calculate in 
that way ; and that he who either follows it him- 
self, or teaches it to others, must be perpetually in 
the habit of committing the most serious blunders. 
Its doses, and the length of time that it Should be 
used, must be entirely regulated by the influence 
it produces on the disease, and its effects on the ge- 
neral constitution. 

Before the disease can be thoroughly destroyed in 
the system, there must actually exist in it for a cer- 
tain length of time a mercurial- disease. The ex- 
tent to which this must be pushed, and the length 
of time that it ought to continue, must be entirely 
regulated by the medical attendant, whose judg- 
ment we shall suppose adequate to the task But 
if his judgment should be deficient, and the course 
of mercury is protracted, the disease must at some 
future period, in one or other form, break out with 
redoubled violence. If, on the contrary, it should 
be unskilfully administered, or carried too far, which 
is by no means uncommon, a disease altogether of a 
different kind from the venereal is produced, which 
exists entirely either in consequence of this injudi- 
cious application, or of too much mercury being ex- 
hibited. Either the original sores will thus assume 
a new character, or new ones will make their ap- 
pearance. The mercury, from the same mistaken 
notions, is still persisted in, the sores become worse, 
(for, being absolutely caused by the mercury, they 
are of course now aggravated, in consequence of 
its use,) and the patient at length becomes hectic, 
and literally cadaverous. Thus he is forced to drag 
out a miserable and wretched existence, burdensome 
to himself, and comfortless to every one else I am 
therefore convinced, that a perseverance in this in- 
discriminate practice has been the ruin of number- 
y 2 



240 

less once vigorous constitutions, even when their ori- 
ginal strength has preserved them a mere wreck of 
their former state. But the numbers who have ac- 
tually fallen a sacrifice to such mistakes, I believe, 
have been still more numerous. 

Thus we will find that mercury, like all other 
active and valuable medicines, can only in one way 
be used properly ; but, from neglect, or other causes 
equally bad, it is daily abused by its too free admi- 
nistration ; while, in some circumstances, the extent 
of its value is not ascertained from its too niggardly 
application It is from due attention to these cir- 
cumstances, that a man at once shows himself pos- 
sessed of discernment and of judgment, and who has 
or has not applied his experience to a proper use. 

Besides, in whatever form we may administer 
mercury, or whatever preparation of it we may deem 
best suited for the removal of the disease, we can- 
not be too careful in its preparation. From inatten- 
tion to this, the complaint is often unchecked 
for a great length of time, even till it has committed 
considerable ravages in the system. Every surgeon, 
as well as physician, therefore, ought never to em- 
ploy any mercury but such as may be prepared either 
under his own immediate inspection, or by some 
person in whom he can place implicit confidence. 

I may observe that, anxious for a speedy cure, I 
have known many patients, independently of parti- 
cular instructions, administer the mercury in by far 
too large doses, which, while it could serve no good 
purpose, either speedily and violently affected the 
mouth, or, what is even worse, occasioned most ex- 
cruciating pains in the stomach or bowels, accom- 
panied by most debilitating purging. These affec- 
tions most commonly arise from mercury taken in- 
ternally ; yet I have, in some few instances, even 
observed such effects induced from its external appli- 
cation in the form of friction. 



341 

Too great attention, therefore, cannot be given to 
the order in which mercury ought to be introduced 
into the system, although it is one of those things in 
practice which is too often entirely overlooked. 
Whether given in the form of pill, solution, or ap- 
plied by friction, we ought to make the doses small, 
and as frequent after each other as we possibly can 
administer them ; or at least, till the mouth be com- 
pletely affected, the former dose should not be allow- 
ed to abate in its action on the system, before the 
following one be given. Thus, instead of giving 
large doses at once, which often create much mis- 
chief, by obliging us not unfrequently to abandon 
it for several days in the same course, we are 
enabled to preserve an uninterrupted action of the 
medicine in the system, which is uniformly most ef- 
fectual in entirely removing the disease. 

On comparing the effects of mercury on the sys- 
tem, whether taken internally in the form of pill 
or solution, or applied externally by inunction, 1 do 
not think there is any considerable difference pro- 
duced by them. The chances, however, of bad ef- 
fects being produced on the constitution in a re- 
markable degree, are most likely to take place from 
the mercury being taken internally, and that only 
when it produces violent effects on the stomach and 
bowels ; even, indeed, v^hen this bad effect attends 
its external application, equally bad consequences 
follow its administration. 

In some patients, too, the internal use of mercury 
is attended with sickness, vomiting, pains in the 
head, and general debility. It is then that its use 
must instantly be abandoned, and some kind of sto- 
machic medicine given to relieve these symptoms, 
which evidently arise from that organ. The mer- 
cury, too, must in future be used externally in the 
form of ointment. 

But when, in the form of pills, it does not affect 
the bowels, occasioning griping or purging, that cer- 
Y 3 



342 

tainly is the easiest mode of using it, and I believe 
is as effectual as when applied in any other form ; 
but when the patient can conveniently confine him- 
self to his chamber, the preferable mode of applying 
mercury is certainly by inunction. The common 
place for applying mercury externally is on the in- 
side of the thighs by means of friction Sometimes, 
indeed, the friction irritates and inflames these parts ; 
but when this effect is likely to be produced by it, 
we ought to rub it once on the inside of the thighs, 
next time on the outside, then on the legs, after this 
on the arms, and when we return to the place where 
we applied it first, the inflamed parts having healed, 
and e may, if necessary, commence the same round 
as before 

If during its exhibition in any of these forms, the 
bowels become affected, we may allay it by taking 
25 or 30 drops of laudanum, an opium pill, or one 
composed of equal parts of opium and gum catechu. 

When the mercury is administered by inunction, 
I usually direct that two or three drams be divided 
and one rubbed on each thigh, opposite a fire, be- 
fore going to bed. I have found the mercury enter 
the system with greater facility when it was mixed 
with a small quantity of fine olive or Florence oil. 
If this produces no effect in ten days on the mouth, 
or on the appearance of the chancre, provided it 
has been immediately attended to, the mercury must 
be gradually, encreased in quantity, adding to it a 
small proportion daily, till one or both of these ef- 
fects appear This may be carried on by itself, or it 
may be combined with a pill taken twice or thrice 
a-day composed of one grain of mercury in form 
of a blue pill, or one grain of calomel in a little crumb 
of bread, or about one sixth or one-eighth of a grain 
of the corrosive sublimate of mercury, first dissolved, 
and then made into a pill with bread, till the effect 
be produced on the mouth, or on the disease, gene- 
rally considered. 



343 

However little the following circumstance is at- 
tended to in practice, (and it is little attended to) I 
may remark that perseverance in the use of any one 
of the preparations of mercury, when it does not seem 
to produce the desired effect, is highly improper, 
and even at times extremely hurtful. For its use 
exhausts the strength of the patient, without in the 
least degree eradicating the virus. Sometimes I 
have found it necessary to change from a weaker to 
a stronger preparation, at other times from a stronger 
to a weaker, when evidently good effects were ob- 
tained in both instances. 

Alterative courses of mercury, however, that is, 
where the system is so very slightly affected as 
scarcely to be perceived, have never, so far as my 
observation goes, been of much benefit in the re- 
moval of lues venerea, unless when the affection 
has been extremely slight, and even then the cure 
has been very slow, and very possibly not complete. 
In severer affections of this nature they seem to 
have no beneficial effects — they tend only to ex- 
haust the system, without checking the disease : I 
therefore conceive, that in every case the mercury 
should be taken in sufficient quantity in whatever 
way it may be applied, sensibly to affect the 
gums, or in a middle state between an alterative 
course and violent salivation. Thus, by regulating 
our doses, so as to preserve the mouth in this state, 
we will more certainly and more permanently cure 
the disease than by either of the other methods. 

The system may be considered as properly charg- 
ed with mercury, when it occasions a general but 
not very disagreeable tenderness in the gums, and 
perhaps in one or more parts of the tongue, with 
foetid breath, and a moderately increased secretion 
of saliva. This state produced and persevered in, 
according to the particular nature or severity of the 
affection, will be found fully adequate to the re- 
moval of either primary or secondary symptoms. 
Y4 



344 

We are taught, by daily experience, in the ge- 
nerality of cases, that the degree of soreness in 
the mouth is the mark by which we are to regulate 
our administration of the mercury. Till this pur- 
pose be effected, all our proceedings carry with 
them some degree of uncertainty ; but no sooner 
does this symptom occur, than we feel more capable 
of regulating our proceedings ; while, in a shorter 
or longer time, according to various circumstances, 
the sores evidently assume a more healthy appear- 
ance. I may here remark, that even with the 
most cautious there often exists great difficulty in 
exactly producing that degree of soreness in the 
mouth which we could wish. In some cases it be- 
comes too violent, while in others, it is with difficul- 
ty we can affect it at all, 

We ought to attend to this, that symptoms of 
lues venerea will often be considerably alleviated 
by mercury, although the disease be not entirely de- 
stroyed in the system. We must not, therefore, 
under these circumstances, desist upon the symp- 
toms only assuming a more favourable appearance ; 
but persevere till we have good reason, from every 
circumstance combined, to believe that the virus is 
completely destroyed. We may establish it as a 
very good general rule in the cure of this disease, to 
continue the use of the mercury probably for two 
or from that to three weeks after every mortaid 
symptom has entirely disappeared. Inattention to 
this is too common, and I believe it is productive of 
much after mischief, rendering a long^ifter course of 
mercury necessary, which, had the former been conti- 
nued perhaps a week or ten days longer, might have 
been entirely avoided. 

One observation I may make here, which I am sor- 
ry to say, is rarely, if indeed ever attended to in prac- 
tice ; viz, that under certain circumstances, even al- 
though the mercury has been most judiciously ap- 
plied, and the disease remains unsubdued, its use 



345 

must not be persisted in, at least for some length of 
time : For instance, when great and permanent 
prostration of strength occurs, frequent nausea, gid- 
diness, pains in the head, and almost constant want 
of sleep, we must entirely abandon the mercury ; 
administer any of the decoctions of the woods, with 
nourishing soups, from two to three glasses of wine, 
or frcm that to a pint or even more each day, till 
these symptoms have abated, and the strength of 
the patient has been considerably restored. Then 
we may recommence the use of the mercury, in one 
or other form, when we reap advantages from it, 
which under the previous circumstances we could 
not obtain. For pushing a mercurial course, after 
a state of great debility has been induced, has, in 
almost every instance, no effect in arresting the dis- 
ease. 

Proper attention not being paid to these points, the 
abuse of mercury is by no means uncommon, and 
I have no doubt that other complaints of a very 
different nature may be produced, either from this 
cause, or by a long continuance of the venereal vi- 
rus remaining in the body ; but I believe they are 
more frequent in consequence of the injudicious use 
of mercury, than even the last. When the system 
is reduced to a state of great debility, the body be- 
comes peculiarly predisposed to complaints which, 
but from that circumstance, might never have oc- 
curred. The disease which may occur is at all times 
dependent on the existing state of the system, from 
whatever cause fctoat state may have been produced. 
Thus, one person in those states, is affected with dropsy, 
another with consumption, &c. not, as has been sup- 
posed, as an immediate effect of the venereal disease, 
but more likely from the great debility which has 
been induced, or immediately in consequence of im- 
proper treatment itself. 



346 



Operation of Mercury. 

The same lymphatic vessels which absorb the ve- 
nereal virus, seem also calculated to convey its anti- 
dote mercury. 

Many strange and truly ridiculous opinions have 
been adduced respecting the modus operandi of mer- 
cury, in its removal of the venereal disease. But we 
seem nearly, or rather as completely ignorant of this 
fact as ever, and the only opinion which, among the 
better informed and thinking part of the profession, 
has yet survived the general wreck is, that the mer- 
cury, meeting with the venereal virus in the system, 
acts chemically upon it, and thus renders its viru- 
lence inert. For my own part, I really think that 
even this last opinion is far from being correct. 

I question very much if mercury has any ef- 
ect on the venereal virus itself; indeed 1 believe 
it does not act at all in this way, (and even if it 
did, it would not in this way remove the disease,) 
but that it produces a change in the constitution, 
which first occasions a complete stop to the rege- 
neration of the virus, and ultimately its total ex- 
tinction. It is then only by this general mode of 
action, that mercury produces its beneficial effects, 
for, externally applied to the affected part, such 
as a chancre, no such destruction of the venereal 
virus is obtained. Indeed, I believe when such sore9 
heal by the external application of mercury in any 
form, it must be either by their emollient or by 
their escarotic quality, not by that substance being 
absorbed, and thus destroying the disease. 

As the venereal virus probably pervades every 
solid as well as fluid belonging to the body, so it is 
reasonable to believe, that the use of mercury con- 
sists in its power of being capable of affecting every 
part where the virus may be lodged, and of ulti- 
mately changing the diseased action of these organs, 



347 

so as to enable them to resume their healthy funo 
tions. 

I may remark, that in whatever form mercury 
may be introduced into the system, we find, all 
other circumstances agreeing, that its ultimate ef- 
fects are the same. Thus, externally applied in 
the form of ointment, by friction the cuticular ab- 
sorbents carry it into the circulating mass. And 
when administered internally, in the form of solu- 
tion, pill, &c. the absorbent vessels, situate on vari- 
ous parts along the intestinal tube, which are more 
active than those on the skin, are sufficient, by their 
own powers, without the aid of friction, to carry the 
mercury into the system. 

The general effects of this active substance on 
the system, when unnecessarily pushed to the great- 
est extent, are very numerous, and never ought to 
exist under proper treatment. The pulse seems first 
accelerated with throbbing of the temporal arteries. 
This is soon followed by prostration of strength, and 
giddiness, especially on rising from a horizontal pos- 
ture. There is now added paleness of face, the fea- 
tures shrink, and acquire a peculiarly unpleasant ap- 
pearance. There is felt a disagreeable taste, which 
gradually increases, and this is soon after accompa- 
nied by a soreness in the mouth, and the gums 
bleed on the slightest violence being applied to them; 
the flow of viscid saliva is also encreased. The head 
is pained, the eyes are tender and somewhat inflam- 
ed, and these are accompanied by dullness and inac- 
tivity of mind. These symptoms generally encrease, 
and the ulceration of the gums cause them to sepa- 
rate from the teeth, which gives a sensation as if the 
teeth were loose. The inside of the cheeks swell, 
and that part which comes in contact with the teeth 
forms a furrow in the cheek, and even in some in- 
stances ulcerates. At length the tongue swells so 
much as to be protruded without the mouth, to 
which the patient cannot return it. The pain in 



348 

the mouth becomes excessively distressmg; from 
which there is now a perpetual and very abundant 
flow of saliva. The patient is now incapable of tak- 
ing nourishment, and even his face is greatly swel- 
led ; his sleep is disturbed, or rather entirely inter- 
rupted, his temper becomes irrascible, and his state is 
truly deplorable Unless the exhibition of the me- 
dicine be now stopt, it may even prove destructive 
of life. 

We should in every case reflect, that, under the 
most judicious application of mercury, pernicious 
effects will sometimes be produced, which may not 
only render a change in the particular preparation 
of that medicine, or in our mode of applying it, ab- 
solutely necessary, but even for a time the total 
suspension of its action on the system. This is a 
very unpleasant state of constitution for the admi- 
nistration of mercury, but it sometimes occurs, and 
nothing but attention to every particular connected 
with the patient's health, with his disease, and with 
every circumstance of his constitution, can alleviate 
or obviate such effects. 

lVIercury then is, in some degree, an universal sti- 
mulant ; and although capable of producing very 
alarming effects, when judiciously introduced into 
the system acts as an antidote to the venereal virus. 
In slight cases, particularly before the glandular sys- 
tem, bones, &.c. bee, me affected, the cure is easily 
and soon completed. But when the disease has ad- 
vanced, so as to affect one or other of these parts, 
the cure is not only more complicated, but, in the 
generality of cases, more tedious 

When mercury does not produce pains in the 
bowels, or violent purging, I have, so far as my 
experience goes, observed, that its effects on the 
system are sooner produced, than when this sub- 
stance was applied externally in the form of oint- 
ment. But when the contrary is the case, when 
purging and griping follow each or any of the doses 



34Q 

of the mercury, the absorbents of the intestines are 
too much stimulated to act in a healthy way, and the 
mercury not being absorbed passes off by stool, 
and consequently cannot produce any effect on the 
disease. 

Those constitutions, indeed, in which the mercu- 
ry seems to produce the fewest evacuations, are 
soonest cured by its use ; and those in which they 
are greatly promoted, are most tedious of cure. In- 
deed, while this last state continues, the disease, in 
general, suffers little or no abatement, — the constitu- 
tion is greatly affected, so much so, that the patient 
is often reduced almost to a skeleton. 

In general, we will find that those who have for- 
merly taken little or none of this substance, are much 
easier affected by it than others who have been in 
the habit of using it for a great length of time. In- 
deed I have met with various cases where two or 
three pills each day, or one dram of ointment, com- 
posed of equal parts of hogslard and quicksilver, ea- 
sily affected the constitution in a few days ; but 
others, or even the same patients, after using mer- 
cury for a long period of time, have been able to 
take four or five times the above quantity without 
being more than slightly affected by it. 

The most favourable state of constitution for the 
exhibition of mercury is, when the venereal symp- 
toms gradually disappear as the mercury takes pos- 
session of the system. The constitution, thus re- 
plete with the mineral poison of mercury, is left 
free from venereal contamination, and from the vi- 
rus ceasing to act, upon its application being with- 
drawn, the inconvenience arising from it is only of 
a temporary nature, generally leaving the constitu- 
tion sound and readily to be acted upon by whatever 
is salutary and nourishing. But if the venereal poi- 
son be not completely extinguished, it continues its 
ravages on the system, which nothing but its total 
destruction can arrest. 



350 

In some instances we find it quite impossible to 
affect the system in any visible way by the use of 
mercury, but if there be produced by it encreased 
action of the circulation, diaphoretic effects, foe- 
tid breath, foetid urine, emaciation, and prostra- 
tion of strength, we are pretty certain of the mer- 
cury having been general in its effects, and will ul- 
timately cure the disease. I think I have observed 
that as the prostration of strength and emaciation 
proceeded, the symptoms of the disease evidently 
abated. 

But, so far as my experience warrants me to state, 
I have observed in such patients a greater propor- 
tion of them afterward affected with secondary symp- 
toms, than in those on whom the mercury had pro- 
duced all the effects expected from it, and where 
the disease evidently abated on these effects being 
observed. 

Without some of these appearances, we have no 
proof that the morbidly contaminated structure has 
undergone the proper change, — that the universally 
pervading influence of the venereal virus has been 
entirely destroyed. 

In almost every case of this disease, perhaps we 
will find that every one of the preparations of mer- 
cury disposes the diseased parts to assume a healthy 
appearance, and fi nally restores them to perfect sound- 
ness. But when this is not the result of such, ap- 
plications, particularly after a great quantity of mer- 
cury has been administered, the sores, &c. become 
worse, then we may be assured that the disease ei- 
ther has not been venereal, and is evidently aggra- 
vated by the mercury, or that it has entirely lost its 
venereal disposition, is kept up by the action of the 
mercury on the system, and cannot be cured till it 
be laid aside, and a different plan of practice pur- 
sued. 



351 



Effects on the Mouth. 

However great the preference may be which men 
have from time to time given to any one particular 
preparation of mercury, it does not appear that either 
of these various preparations have, in general, even 
in the hands of their greatest admirers, produced 
any very beneficial effect till salivation in a greater 
or less degree was produced. This seems to be the 
general effect necessary for the regulation of our pro- 
cedure in all constitutions, before we can positively 
determine that what we expected from it will follow. 
Yet we find in certain habits, that salivation may be 
produced and continued for some time without any 
remarkably good effect ; but when the preparation 
has been altered for another, although the salivation 
is not encreased, the symptoms of the disease begin 
to abate, and are speedily cured. What can be the 
reason of this ? 

The visible effects of certain preparations of mer- 
cury, not only on the disease, but on the mouth, sa^ 
li vary glands, &c. are various in different individuals, 
and even in the same individual at different periods. 
For we sometimes find that a very small proportion 
of that medicine, either in the form of ointment, 
pill, or solution, will at one time produce salivation, 
while at other times it is necessary to employ a very 
large proportion to produce any visible elfect on 
these parts. Thus, we see the necessity of acting ac- 
cording to circumstances, rather than being guided 
by an y general rule in our administration of that 
medicine. 

I think I have frequently observed, that when a 
patient takes a great deal of mercury before he is 
affected with it as above, when the salivation did 
commence it was excessive; this circumstance ought 
to put us on our guard when this state of the sys- 
tem Gomes in our way. 



352 

In others we find, after one or two doses of mer- 
cury have been administered, the mouth will become 
very sore, and salivation will be present to a consi- 
derable extent. But this, on the mercury being dis- 
continued, usually abates in a few days, and we in 
general find that recourse may be then had even to 
larger doses of the mercury than before, without 
producing any thing beyond moderate soreness of 
the mouth. 

Sometimes, too, independently of our greatest cau- 
tion in the exhibition of mercury, the patient shall 
be suddenly and unexpectedly seized with the most 
violent salivation. This being, in every kind of ve- 
nereal complaint, always unnecessary, and sometimes 
even hurtful, is an unfortunate occurrence. But 
when such violent salivation is brought on by de- 
sign, I do not hesitate to assert that the physician 
acts extremely wrong. From the violent inflamma- 
tion, and often ulceration, which it occasions in the 
mouth, it causes to the patient great and unneces- 
sary suffering. But a greater evil still is the conse- 
quences of such procedure. By it we deprive our- 
selves of the best sign we have of ascertaining the 
probable state into which the system has been brought 
by a slighter degree of salivation, as, when this in- 
flamed or ulcerated state of the mouth has once been 
produced, we are obliged to abandon the use of the 
mercury, and often continues in this state a consi- 
derable length of time, alter the general system, con- 
sequently the disease, is in the smallest degree af- 
fected by the medicine. Thus we are deceived, and 
the disease is suffered daily to gain ground, which, 
from the above cause, seems to us unaccountable as 
the mouth continues sufficiently sore ; yet even then, 
the patient's system is as free from the mercury as 
he had never used it. I may observe also, that the 
consequence of such a state of the mouth, is the 
cause of much after distress. I have at present a 
gentleman under my care, who has come to Edin- 



353 

burgh from a distant part of the country, in a most 
deplorable state. He caught a pox several years ago, 
and his medical attendant, not being much in the 
habit of treating such complaints, alternatively sali- 
vated and purged him most unmercifully. In this 
state he continued many months, and before he was 
dismissed cured, his bones, throat, and even nose, 
had suffered considerably. He seems now to be free 
from the disease, but the immense thickening of 
some parts of his mouth, and the strong adhesions 
which have taken place in others, render his condi- 
tion extremely distressing. I am at present employ- 
ed in occasionally dissecting the parts where neces- 
sary, in order, if possible, to enable him to open his 
mouth, which he has not been able to do, to nearly 
its natural extent, for several years. I think, from 
the progress I have already made, I shall in a great 
measure effect my purpose. 

Violent salivations are thus not only injurious by 
their immediate effects, but their after consequences, 
as just stated, on the mouth, &c. are very distressing. 
The debility, too, even in the strongest constitutions, 
independently of the circumstances now stated, and 
the absolute danger which sometimes arise from 
them to those of weaker habits, will at all times have 
great influence with the cautious practitioner. 

If the salivation should become very profuse, the 
local application as a wash to the mouth of an infu- 
sion of oak bark, a decoction of galls, diluted lime 
water, or a solution of borax, are all very useful in 
keeping the mouth cleaner and easier than it would 
be without them. If costiveness prevail, of course 
a dose of physic will also be of great service. 

Mercury often affects several of the secretions at 
the same time ; but in order that we may be regu- 
lated in our administration of it, our principal atten- 
tion must, independently of particular exceptions to 
the rule, be directed to the effects it produces on 
the mouth. By attention to this, in almost every 
z 



354 

case, we shall be able to regulate our doses so as to 
ensure the greatest success from its application. Not 
only does the breath, when the mouth becomes suf- 
ficiently affected, acquire a very disagreeable smell, 
but in some, more than in others, the same sort of 
smell, in some degree, seemingly issues from the 
whole surface of the body. 

Sometimes great pain in the mouth is experienced 
during a course of mercury, from the presence of a 
decayed tooth, which previous to that gave no un- 
easiness. When, therefore, these pains become ex- 
cessively troublesome, we ought to examine the 
mouth, and remove such teeth as may be in some 
measure the cause of this painful feeling. 

Diarrhoea. 

We never ought to use purgative medicines either 
immediately before or during a course of mercury, un- 
less when, from a constipated state of body, they are 
absolutely necessary. By their too free use, which 
is no uncommon practice, we are apt to induce that 
state of the bowels which, during the course of mer- 
cury, will almost infallibly occasion diarrhoea. Thus 
the venereal disease itself is not only unchecked, but 
the patient is ultimately exposed to a much greater 
degree of debility than is necessary. 

In some patients, independently of the use of pur- 
gatives, the first or second doses of mercury often 
occasion considerable griping and purging ; but this, 
even without the use of opiates, or any other me- 
dicine, soon abates, when mercury may be admini- 
stered without occasioning any such inconveniency. 
It is proper, however, during such symptoms, to ad- 
minister an opiate or some other medicine for their - 
relief. 

In some the diarrhoea is obviated, throughout the 
whole course, with the very greatest difficulty. In 
such patients, the greatest possible attention, both 



355 

on the part of himself and his medical attendant, is 
absolutely necessary. 

Exposure to Air. 

It is extremely fortunate, that after almost every 
mercurial course, unless it has been very ill con- 
ducted, the patient, although emaciated, is in high 
spirits, his appetite is good, and his victuals soon re- 
store his corporeal deficiency. In short, I believe 
there is no disease, or rather no remedies necessary 
for the removal of disease, which reduces the body 
so much, and which is so soon restored by nourish- 
ing diet, moderate quantities of wine, bark, and free 
and dry air. 

It has been observed, that the cure of lues vene- 
rea is more difficult, or rather more tedious, in cold 
climates than in warmer latitudes, and this has given 
rise, I think, to much unnecessary speculation. We 
all know that during a course of mercury, the most 
speedy effects of it in arresting the progress of the 
disease, are obtained while the patient is under con- 
finement ; but this degree of temperature (though 
the contrary is asserted by authors) evidently acts on 
the remedy applied, not as producing any specific 
effect on the nature of the disease itself. Exposure 
to cold, on the contrary, particularly if the air be 
damp, is in almost every case injurious. Griping in 
the bowels and purging are the common consequen- 
ces, but this can never be said to be owing to the ef- 
fects of the cold, &c. on the disease itself; for, if 
previous to this the mercury has been administered 
in the form of pill or solution, changing either of 
these forms, and applying it in the form of an unc- 
tion, will in almost every case prevent the above ef- 
fects, even although the patient be exposed to the 
same degree of cold as formerly. 

I have no wish to inculcate the propriety of a pa- 
tient going at large during a course of mercury, tin- 

22 



356 

less confinement would be a great inconvenience to 
him, and even then only during mild forms of the 
disease, when a severe or a long continued course of 
mercury is unnecessary. I know that there is con- 
siderable risk in a patient being much in the open 
air when the disease has affected him severely, or 
when he is under a violent salivation. Besides, the 
appearance of such a patient is so disgusting to peo- 
ple in general, from his haggard and cadaverous 
countenance, with a stench issuing from every part 
of his body, especially his breath, — that, indepen- 
dently of the danger, a sense of propriety ought to 
prevent him from being exposed to the chance of 
seeing company. 

It ought to be a never forgotten rule, although 
seldom attended to. in the treatment of these com- 
plaints, when confinement is absolutely necessary, 
regularly to ventilate the apartment at least once 
a-day. This may be done while the patient adjourns 
to another room during that process. 

With respect to exposure to the influence of the 
atmosphere during a course of mercury, I conceive 
that no general rule can be laid down for it, as we 
must be entirely regulated in our conduct by the ef- 
fects it produces. I myself know perhaps as many 
gentlemen who have taken mercury with the very 
best effectj although every day exposed to the influ- 
ence ot the external air, as have suffered under a 
similar course from the same cause. One general 
rule, however, ought to be observed, that all damp- 
ness and excessive heat, from whatever cause, must 
be avoided. 

Although unnecessary in. all then, yet in some par- 
ticular i onstitutions, it is absolutely necessary, un- 
der every course of mercury, to enjoin strict con- 
fi ement. 

in such as I have alluded to, the slightest ex- 
posure to the common atmosphere, almost imme- 
diately causes griping and purging, which are at 



357 

Such 'times always unfavourable occurrences. In 
some, I have even observed this peculiarity of dis- 
position continue for weeks, or even months, after 
it had been found unnecessary to discontinue the 
course of mercury. 

But, by a little attention, we will perceive that at 
these times the bad effects of such exposure, is 
more generally occasioned by a sudden transition 
from one extreme to the other, than by exposure 
to that uniformity of temperature to which those 
under such medicine ought always to be exposed. 
I am, therefore, fully of opinion, that, previous to 
confinement, exposure to a dry and moderately cold 
atmosphere can do little or no harm ; but if, after 
confinement, even for a single day, has been adopt- 
ed, the patient ought not, unless in the very best of 
weather, to expose himself to the cold, particularly 
if damp, till he is completely cured When I men- 
tion exposure to the common atmosphere, I do not 
mean, that in addition to this we may use our ac- 
customed exercise as in health ; for, in no form of 
the venereal disease is a patient justified in using 
much exercise, as, by doing so, he is very apt to 
create to himself much unnecessary uneasiness. 

Whether or not we may judge it necessary to de- 
sire the patient to remain in the house, it is always 
proper, under the operation of that medicine, to or- 
der flannel shirts and drawers to be worn during the 
winter, and calico ones during the summer months. 

It will always be found that much less mercury 
is necessary to cure the disease under confinement, 
than if the patient be allowed to go daily into the 
open air. 

Confinement to the house, then, or allowing the 
patient to be much in the open air, must, like the 
regulation of our conduct in various other circum- 
stances, respecting both the disease and its cure, be 
entirely regulated by the effects which the one or 
ether of these methods have in the removal of the 
Z 3 



358 

disease. If the summer air, for instance, produces 
no unfavourable symptom, why use confinement, 
which, of itself, is at all times debilitating ? and if 
the air seems to have a bad effect, it would be mad- 
ness to continue exposing the patient's health to its 
bad effects I lately, for instance, attended two 
gentlemen at different periods, who were very dif- 
ferently affected by the mercury, although both 
were ultimately cured of their complaints. One of 
them had previously undergone a course of mercury, 
and then, as well as on the occasion I have alluded to, 
could not be half an hour exposed to the air, even 
in the best weather, without being subject to a vio- 
lent diarhoea, and the most painful griping in his 
bowels. But these speedilyand entirely left him when 
he betook himself to his chamber. The other had 
been uncommonly unfortunate in his amorous en- 
counters, and, for a succession of venereal com- 
plaints, had taken mercury almost constantly for 
three years. During all that period he was scarcely 
ever confined a single day, and his complaints all 
disappeared as speedily as could have been expect- 
ed, even under the very strictest confinement. 

When, therefore, exposure to the atmospheric air 
is not, to a patient under a course of mercury, abso- 
lutely hurtful, it ought always to be permitted. 
Constant confinement within doors, besides other in- 
conveniencies, depresses the mind, and renders the 
patient doubly uncomfortable. On the contrary, 
all other circumstances agreeing, moderate exposure 
to a free dry air enlivens the spirits, prevents, in a 
great measure, the debilitating effects of the medi- 
cine, and, indeed, renders the system, if it be deem- 
ed necessary, capable of having, with the best ef- 
fect, a larger quantity of mercury administered than 
can be done under any other circumstances. 

Whether or not from the particular and already 
formed opinions of the medical attendant, the pre- 
ceding conduct be adopted, we always find, that af- 



359 

ter, or even during, the latter period of a long con- 
tinued course of mercury, it is always proper, as 
sanctioned by every medical gentleman, to remove 
the patient to some country situation, where the air 
is pure, but not damp ; and where, so soon as he 
may be able to walk abroad, he may enjoy all the 
numerous benefits arising from such a situation. 
When the mercury has entirely left the system, te- 
pid bathing, or even cold sea bathing, or the cold 
bath in any sort of water, is highly beneficial. 
These, with nourishing diet, a moderate quantity of 
wine, with gentle exercise, seldom fail of speedily 
restoring the strength, often very rapidly, to its for- 
mer vigour. 

Frequent repetitions of lues venerea, or rather 
with the abuse of the remedies found absolutely ne- 
cessary to destroy it, is extremely destructive of the 
constitution : perhaps the mode of living, too, which 
generally leads to the chances of frequent infection, 
has no inconsiderable share in at length producing 
such effects as we sometimes solely attribute as con- 
sequences of the disease alone. From these com- 
bined effects, the train of complicated sufferings, 
which, even in early life, many are doomed to bear, 
is truly afflicting. Even the stout and robust, whose 
appearance bade fair tor good health and long life, 
becomes but a wreck of what he was ; and in conse- 
quence of this, from his being almost constantly af- 
fected with one or other chronic disease, his exist- 
ence actually becomes a burden to him Prema- 
ture age and early death \n general close the miser- 
able scene. 

i i i 

24 




360 



APPENDIX L 



CRITICAL EXAMINATION 

OF 

MR HOME'S WORKS 

ON 

STRICTURE IN THE URETHRA, 

Sfc Sfc 



Mr Home, near the commencement of his first 
volume, endeavours to prove the muscularity of the 
membrane of the urethra, but seems obliged to take 
a good deal for granted. I may, however, observe, 
that if we possessed a completely contractile power 
of the membrane of the urethra, paralysis of the neck 
of the bladder would not cause incontinence of 
urine ; since, by the contraction of the urethra, it 
might be retained. We have then no proof what- 
ever of this membrane possessing any contractile 
power ; and the proofs Mr Home has given of this 
are insufficient, viz. the state of it during the pass- 
ing of urine and semen, and the effect produced on 
it by the use of injections in gonorrhoea. For, while 
the urine passes, the muscles of the penis are gene- 
rally flaccid, and consequently allow the membrane 
to be easily distended ; but during the emission of 
semen, these muscles being suddenly and violently 
contracted, compress the membrane, and thus it is, 






36 1 

at that time, rendered narrower ; and the same ef- 
fect is produced on these parts during the use of in- 
jections. Mr Home constantly runs into error in 
this way, as if not aware that the muscles have any 
effect in compressing the urethra Having presum- 
ed the muscularity of the membrane of the urethra, 
he proceeds to give the following account of its in- 
fluence in the production of stricture. 

" Contraction and relaxation," says he, (vol. I. 
p. I9.) " are the natural and healthy actions of the 
urethra ; but this membrane, like every other (part 
of) muscular structure, is liable to a spasmodic ac- 
tion, which produces a degree of contraction beyond 
the natural ; and in that state the canal loses the 
power of relaxing till the spasm is removed When 
this happens it constitutes disease, and is termed a 
spasmodic stricture. 

" While a stricture is in this state, it is only a 
wrong action of the membrane of the urethra ; and 
if the parts could be examined in their relaxed state, 
there would be no appearance of disease. 

" When a portion of the urethra is disposed to 
contract beyond its natural easy state, this disposi- 
tion commonly increases till the part becomes inca- 
pable of falling back into a state of complete relax- 
ation, and the canal remains always narrower at that 
part. 

" In this stage it is both a permanent stricture 
and a spasmodic one. It is so far permanent, that it 
is always narrower than the rest of the canal ; and 
so far spasmodic, that it is liable to contract occa- 
sionally in a still greater degree." 

This, in all probability, is the most correct ac- 
count of the formation of strictures that can be 
given ; indeed I believe it is in this way that almost 
every stricture is formed ; and it is only by neglect 
of them in their early stages, or by harsh and un- 
warrantable treatment, that they ultimately become 
of a permanent nature, or require the complete de- 



362 

struction of their substance, before they can be re- 
moved ; and even after all this, the patient is often 
not relieved, but obliged to drag out a life of perpe- 
tual misery. 

Mr Home himself seems of this opinion, in p. 23, 
speaking of spasmodic strictures, and their effects in 
the producti n of permanent ones, he says, " A 
stricture having arrived at that stage which renders 
it permanent, does not prevent it from having also 
a spasmodic contraction. This, however, in many 
instances, is in a less degree after the disease has 
been of some years continuance, than at a more ear- 
ly period ; for we find patients who have been sub- 
ject to occasional suppressions, afterwards entirely 
free from them, the disease in its increase having 
rendered the parts more indolent, and therefore not 
so readily affected by accidental causes; but when 
the stricture becomes very small, the occasional sup- 
pressions return, and become more serious" To 
this I would answer, they certainly do ; but, under 
the above circumstances, had proper precautions 
been used, no such serious termination need have 
been feared. In short, to sanction the frequent use 
©f caustic, it is absolutely necessary for its advocates 
to admit of more or less spasmodic action in all 
cases, where what is termed permanent stricture is 
supposed to exist. This is indeed Mr Hunter's opi- 
nion, but, by mistake I suppose, differently mould- 
ed by Mr Home. If by any one it be asserted that 
permanent stricture exists, and if, at the same time, 
he wishes only to prove the existence of spasmodic 
stricture, it may be urged that it is purely of that 
nature ; and if, on the contrary, it be contested that 
it is purely spasmodic, it may be admitted that 
spasm does exist, but that it is in consequence of a 
permanent obstruction of the canal, which can only 
be relieved on the removal of the obstruction. 

To prevent repetition, I wish it to be particularly 
understood^ that it is to Mr Home's practice alone 



363 

that I here object; and. of his theories I shall take 
notice only when they seem likely to lead to erro- 
neous practical conclusions. Mr Home, in p. 31, 
makes the following remark : " It will appear evi- 
dent, that a contraction of any particular part of the 
canal may be brought on by an unusual or preter- 
natural degree of action in the membrane itself, 
without any new formation whatever." It need 
hardly be stated, that, in order to form a contrac- 
tion of any natural canal, possessing, as I have en- 
deavoured to show, no muscular power, additional 
substance is absolutely necessary. 

" A gentleman," says Mr Home, in p. 52, " in 
the act of copulation, telt, at the instant the emis- 
sion should have taken place, considerable darting 
pain in the urethra, and found afterwards a few 
drops of blood upon his linen ; about an hour after, 
he had occasion to make water, and, in preparing to 
do so, the semen which should have been emitted, 
appeared upon his shirt in considerable quantity. 

" I was consulted upon the cause of such very 
unusual ! and distressing ! circumstances. On hear- 
ing them stated, I informed him that there must be 
a stricture in the urethra, which alone could ex- 
plain what had happened ; this he was inclined to 
doubt, as he made water very well ; but, upon pas- 
sing a bougie, (which alone caused contraction) an 
obstruction was met with just beyond the bulb of 
the urethra ; and upon allowing the bougie to re- 
main, with slight pressure against the stricture for 
a few minutes, it was capable of being passed on 
to the bladder." Now, all these circumstances are 
easily explicable, without supposing the existence of 
stricture. During the act of emission, rapid con- 
traction happened in the sphincter vesica, which 
closed the apertures of the vasa deferentia ; and 
when relaxation occurred, to allow the passage of 
the urine, the semen also escaped ; and it is in the 
same manner that semen is often emitted in great 






364 

quantity immediately after the orgasm. When the 
bougie was introduced, it had stopped at a small 
eminence, situated at the under side of the neck of 
the bladder, which often interrupts the introduction 
of the staff", and having by pressure ov< r< ome this, 
the bougie entered the bladder. Thus the gentle- 
man himself judged correctly, upon observing that 
his water passed " very well," that he really had no 
stricture. 

In p. 56, a case is related to show the similarity 
between stricture and gonorrhoea. But this seems 
to be a case neither of stricture nor of gonorrhoea, 
but simply a temporary spasmodic affection, with 
which people advanced in life are often affected, 
when they worship the Cyprean goddess. 

In p. 62, Mr Home informs us, that strictures 
cause fatal peritonitis ; and this he thinks extraor- 
dinary, as there is no immediate communication be- 
tween the bladder and abdomen He seems to have 
forgot that the bladder is covered by the peritonas- 
um, and that absolute contact is immediate com- 
munication. 

I cannot find, in all Mr Home's detail of local 
symptoms of stricture, a single one which I have 
not seen in cases purely of a spasmodic nature, and 
which, when attended to in time, I am daily in the 
habit of removing, by the properly regulated use of 
internal medicines, external applications, and the 
occasional judicious use of the simple bougie. 

The constitutional symptoms of stricture men- 
tioned by Mr Home, are principally of a febrile na- 
ture, attended with cold, hot, and sweating stages. 
In respect to this part of the subject, I may remark, 
that I have seldom met with a very violentcase of spas- 
modic stricture, in which, at some period or other of 
the disease, these occurrences did not take place. I 
must, however, admit that I have never met with the 
different stages following each other so accurately as 



365 

those in which Mr Home has observed them. All 
this I conceive to be of little importance, and it 
can surely never be adopted as a diagnostic symp- 
tom of the affection. I think these fits of ague, as 
they are called, may be accounted for in a more ra- 
tional way : ist, From matter being lodged about 
the perinoeum, in consequence of previous impro- 
per treatment of the affection, which, assisted by 
the dread into which the patient is thrown by the 
very thought of having a caustic bougie thrust in- 
to the urethra, will occasion the cold fit; and, 2dly, 
From the pain occasioned by the actual application 
of a caustic bougie wedged into the stricture. 

With respect to the case of stricture, treated as 
an ague in p. 66, I think Mr Home's conclusion 
erroneous. He says, " I have had a patient under 
my care, who for three years had this constitution- 
al symptom of stricture in the West Indies, which 
was treated in that country as an irregular ague ; 
but not finding himself relieved, he came to this 
country, and it was discovered, (by Mr H. of course) 
that he had strictures in the urethra ; upon the re- 
moval of which, the ague disappeared, without the 
use of any internal medicine." 

From Mr Home's mode of relating this case, it 
is evident that he had no symptom to warrant him 
to suppose the existence of stricture in the urethra, 
except those usually found in cases of ague. When 
we consider that, in ail probability, the gentleman 
lived, while in the West Indies, in some situation 
where ague might be an endemic disease, and that 
on his return to England, he was removed from the 
very cause of his complaint, in a few weeks he 
might have been entirely freed from it, without ei- 
ther the use of medicine or caustic. 

Mr Home tells us in another place, that strictures 
have been mistaken for nervous fever ; that they 
cause inflammation of the tonsils I fauces ! &c. In 
short, it would appear from such statements, that 



366 

strictures may be found to cause all the diseases that 
ever either had existence, or were invented by no- 
sologists. 

The cases of irritable urethra, mistaken for stric- 
ture, (p. 75.) according to the account given of 
them, appear much better fitted for the application 
of caustic, than many of the cases related in the 
book. Accidentally, however, a simple bougie was 
preferred, and proved successful. An injection of 
of oil with a small proportion of tinct. opii, into the 
urethra,, might have answered the same purpose. 

What is the nature of the action produced by the 
application of the caustic, in those cases of irritable 
urethra, related by Mr Home, where even he allows 
that no stricture exists ? It must be an entire de- 
struction of the parts that have become morbidly ir- 
ritable, and are incapable of resuming their healthy 
action by any power they themselves possess ; or it 
may not entirely destroy the parts, but only cause 
an alteration of a more healthy nature to take place in 
them, by which they are rendered capable of perform- 
ing their natural functions. To effect this last purpose, 
without running the risk of entirely destroying the 
organization of the parts by caustic, at least deserves 
some attention, and I have no doubt of our being 
able to accomplish our object. 

The very earliest stages of stricture, before it 
has acquired that condensed form which nothing 
but the application of caustic or an instrument can 
remove, is certainly the time when surgeons ought 
to be most active and vigorous in their exertions for 
its removal. I do not hesitate to say, that it is in 
these moments a surgeon shows whether he is actu- 
ated by the powers of discrimination, by which his 
applications shall be external or internal, as the par- 
ticular circumstances of the moment shall require ; 
or if his sole dependence is on one remedy, viz. the 
lunar caustic, by which, indeed, he may effect a 
cure, but in doing so must run many chances of in- 






367 

volving his patient in great misery, perhaps for the 
remainder of his life. 

Mr Home, in page 109, in a note, informs us of a 
physician in London, who certainly carried his aver- 
sion to the use of caustic too far in the removal of 
permanent stricture. He was seemingly as much 
wedded to one side of the question as Mr Home is 
to the other. The physician, it is said, left his for- 
tune to his nephew, solely on condition, that, al- 
though the uncle knew him to be affected with 
strictures, he was not to undergo the burning pro- 
cess for their removal. The nephew complied with 
these conditions, and Mr Home says, he afterwards 
died in great misery. " In this case," says he, " it 
was found afrer death that the urine, prevented by 
the stricture from coming forward, had forced its 
waij backward upon the intestine, instead of coming 
through the perineum; and the first symptom that 
gave alarm, was that of the foeces coming through 
the penis with the urine." 

By what way urine, prevented from being evacu- 
ated in the natural way, could be forced backward 
into the intestine, and the passage which thus con- 
ducted it back, enable not only it but even the foe- 
ces to overcome the stricture, and pass off by the 
penis, is to me a most inconceivably mysterious oc- 
currence. 

In the very early stages of stricture, while yet 
there remains a great degree of spasm on the parts, 
and when, in a great majority of cases, the bougie 
cannot be introduced without occasioning the most 
excruciating pain ; Mr Home talks with as much 
coolness of the irritation, as he terms it, which is 
often brought upon the strictured part, as if he were 
thrusting his finger into an easy glove, not as if he 
were introducing an instrument in this unprepared 
state into a canal, which, from its morbid state, is so 
susceptible of the most acute sensation. In page 
1 10, he condemns the principal means, viz. internal 



3(38 

medicines, by which these effects were to be obvi- 
ated, because, according to his theory, " no inter- 
nal medicine appears capable of stopping the pro- 
gress of a stricture." But, and I do not state it in 
support of any particular theory. I am in the constant 
habit, especially if applied at the commencement of 
the affection, by the properly regulated use of internal, 
and the properly regulated employment of external 
applications, of entirely and permanently removing 
affections of the most violently spasmodic nature, 
which in all probability would have terminated in 
permanent strictures. In short, under the existence 
of these contractions, no man is warranted to use the 
bougie, without having previously employed other 
means. According to Mr Home, the simple bou- 
gie, for the distention of contracted parts, is only of 
temporary benefit ; and, in the way he proposes, this 
was the best effect which could arise from such 
practice. 

That Mr Home has acquired from habit a degree 
of dexterity in the application of the caustic, no one 
will question ; and where strictures of a permanent 
nature actually do exist, I believe, there is scarcely 
any other surgeon who would be so often successful 
in their removal. But when it is recollected that it 
is not the manual dexterity alone of one or more 
individuals that can establish a doctrine on scientific 
principles, and that Mr Home, in detailing his own 
successful treatment of what he conceived to be per- 
manent strictures, is addressing himself to many 
other persons, not so dexterous, it is scarcely to be 
calculated what an immense number of blunders 
may be made, not only in mistaking the actual ex- 
istence of permanent stricture, but in their deficient 
dexterity in the application of the caustic. The 
seat of the disease, as related by him, the nature and 
shape of the canal, and the uncertainty of the num- 
ber and site of these strictures, together with the 



369 

impossibility, in the hands of many, of applying the 
caustic bougie to the exact spot where the obstruc- 
tion lies, as well as the probability, considering the 
escarotic nature of caustic, of destroying every sub- 
stance to which it is applied, ought at all times to 
induce an exertion to prevent a complaint arriving 
at that pitch of severity, when such applications may 
be necessary ; and to occasion a pause before it be 
applied, especially when the propriety of those mea- 
sures cannot actually be demonstrated. 

In former periods, the most commonly preferred 
plans of operating, for the removal of permanent 
stricture, formidable as they may appear to some, 
were, considering the circumstances I have stated, 
more certain of effecting the exact object which the 
surgeon had in view, than the modern attempt to 
apply caustic through a long narrow passage such as 
the urethra, where nearly the whole extent of the 
healthy part of that canal must be cauterized as ef- 
fectually as the part intended actually to be destroy- 
ed. 

The most approved of these operations were, dis- 
secting down upon the strictured part, and cutting 
it out ; the other, by making an opening rather ante- 
rior to the stricture, and passing a flexible gum ca- 
theter through the opening into the bladder. Even 
Mr Home allows that he has frequently seen this 
operation successfully performed by John Hunter, 
and no untoward symptom occur. 

From this Mr Home observes, p. 130, that " if the 
membrane of the urethra, when diseased, is capable of 
suffering so much injury, without any consequent 
symptom of irritation, it cannot be doubted that it 
will bear with impunity to be touched in a very partial 
manner, several times with lunar caustic." But^ 
upon the very same principles, we may conclude, 
that because a man can, without exhibiting signs of 
the utmost torture, suffer a cut to be made in his 
finger, that he will bear with impunity to have hia 
Aa 



370 

whole hand seared over with a red hot iron ! The 
metaphor is just; for, according to the present mode 
of cauterizing the urethra, I have no idea of a par- 
tial application of caustic to that part, and it is ab- 
solutely disgusting to hear it talked of. Seven inch- 
es, or, according to the common language, seven and 
a-quarter, must, less or more, according to the 
dexterity of the operator, be injured by such appli- 
cation. If the urethra does not receive much mis- 
chief from removing the stricture nearest its orifice, 
it must be completely destroyed before the removal 
of the second, third, fourth, fifth, or God knows 
how many more ! which are everlastingly found 
snugly situated nearer the bladder. 

In the following paragraph, p. 131, Mr Home is 
certainly right, when he informs us, that " his ob- 
servations are published with a view to extend the 
use of the caustic to a greater variety of cases, and, 
in some measure, upon a very different principle 
from that upon which it was applied to in impervious 
strictures, by the late Mr Hunter." Further on he 
says, " he wishes to place the merit of the inven- 
tion, as well as the mode of applying it, where it 
was due," viz. to Mr Hunter, a name which, by the 
bye, Mr Home introduces on every occasion where 
he is in want of respectable authority to support a 
repulsive doctrine. I wish Mr Hunter were still 
alive to give us his opinion. 

I really find so much may be said respecting Mr 
Home's practice in stricture, that I fear my readers 
may imagine I do it from pique ; but I assure them 
that is not the case, as nothing is farther from my 
intention. I have no knowledge of Mr Home but 
from his writings, and even if I had, I hope neither 
himself nor any liberal enquirer after truth will ima- 
gine, that there possibly can be any thing personal 
in my remarks. I have no particular interest, ei- 
ther in his success or want of success ; it is matter 
of fact and sound reasoning alone, that I have been, 



371 

and I hope always shall be in pursuit of, and I am 
sorry that, I cannot think I have found enough 
of it, even in many of the best medical publica- 
tions. But to the point: In p. 13 2, Mr Home, 
not contented with applying caustic for the remo- 
val of what he terms permanent strictures, strenu- 
ously recommends its use, in preference to the bou- 
gie, in what he terms irritable strictures ; in other 
words, I suppose he means spasmodic strictures. I 
trust I do not misunderstand him, for I have no 
wish to do so ; however, if I do, I shall be glad to be 
put right. I hope Mr Home succeeded in all the 
cases of this nature, in which he attempted the in- 
troduction of the caustic ; I say I hope so, for if 
such strictures resembled those of the same kind 
which are constantly occurring in practice in this 
place, there must be a peculiar charm in his mode 
of applying that substance so as to cure them. I 
formerly stated, that in such cases, internal medi- 
cines, external applications, and the occasional and 
most judicious use of the simple bougie, were all in 
their turn necessary to effect this purpose ; that 
burning away these strictures was merely removing 
the effect of the spasm for a short period ; for the 
cause still continuing, the constriction would again 
and again occur, not probably in the same place to 
which the caustic was formerly intended to be appli- 
ed, but to every part of the urethra, and possibly to 
eight or ten different parts of it at the same time to 
which it actually was applied. 

Mr Home gives two long cases in proof of this 
part of his doctrine. He passed bougies repeatedly 
into the urethra of both patients, till he brought on 
the most alarming symptoms, among which were 
abscess in perinseo, when he deemed it prudent to 
desist. He then applied the caustic a variety of 
times in each instance, and, after occasioning great 
distress to both patients, he cured them. 
Aa2 



372 

In the cure of diseases in general, and of stricture 
probably among the rest, there is usually for days 
or weeks previous to a complete cure, a gradual ap- 
proach towards that state. But, in not a few of 
Mr Home's cases, we find the patient perpetually 
racked with the most agonising pains, either from 
the nature of the disease, or from the peculiar qua- 
lity of his instruments of cure ; and before we have 
had a moment to recover from sympathizing with 
the wretched patient's sufferings, we find him dis- 
missed cured ! 

Mr Home then, p. 150, enters into a long apo- 
logetical oration, with an attempt, at the same time, 
to show (from instances of other parts of the body 
suffering violence, without danger) with what safe- 
ty caustic may be applied to the whole internal 
membrane of the urethra. 

He says, " spasms in particular muscles, as in the 
intercostalis, diaphragm, muscles of the arm or leg, 
come on from slight constitutional irritation, or lo- 
cal injuries, attended with little violence ; the cause 
is often so slight, as entirely to escape discovery, 
and the treatment most generally found to succeed, 
is blistering the surface nearest the part affected, 
which is one of the most violent applications we are 
enabled to employ." Had Mr Home transferred 
the same sort of reasoning, and the same practice, 
to those strictures in the urethra of a spasmodic 
nature, with the judicious addition of other articles, 
which taken internally, or applied externally, might 
tend to produce similar effects ; — had he done so, I 
say, much unnecessary suffering might have been 
avoided by some who have had courage to submit 
to such rarely necessary practice, as the burning of 
the membrane of the urethra. Indeed the appli- 
cation of caustic bougies to the membrane of the 
urethra, in these strictures, acts in their removal, on 
the same principle as a blister applied to the peri- 
neum, or under part of the penis ; only with this 
difference, that in the first, some portion of the 
membrane of the urethra must be destroyed, and 



373 

much damage to the canal in general, will probably 
be the consequence ; while in the oiher, viz. blis- 
tering externally, aided by internal medicines, &c. 
the stricture is removed without doing the slightest 
injury to these parts In p. 1 55, even Mr Home 
seems sensible of this, for he says, " This general 
principle of spasmodic affections and local irrita- 
tions, yielding more readily to stimulating applica- 
tions, is now found equally applicable to affections 
in the urethra." I agree with him, we only differ 
in our mode of applying them. He burns off the 
very structure affected, and at least every part ante- 
rior to it, with lunar caustic ; while I endeavour to 
remove it by antispasmodics, blisters, the occasion- 
al use of the bougie, &c. without injuring the struc- 
ture at all. No doubt can be entertained which is 
the easiest and safest way ; and there is no one ca- 
pable of reasoning, but must be convinced of the 
permanent benefit of the latter, in preference to the 
former. 

in p. 158, Mr Home commences a comparative 
enquiry respecting the bougie and the caustic. He 
says, " It is not my intention, by any means, to 
discourage the use of the bougie, which is certainly 
a very useful instrument ; but as it is found to be 
limited in its powers, it becomes important to point 
out a more active application, which may be capable 
of producing a cure, where that shall have proved 
inadequate." On the contrary, then, I should, ac- 
cording to his mode of using the bougie, entirely 
discourage it, as, when applied in that way, it is not 
only very limited in its powers of relief, but pro- 
ductive of the most exquisite distress to the patient; 
yet, when more scientifically applied, and that in 
the early stage of stricture, it is preferable, and will 
ultimately be preferred to the lunar caustic. 

The remaining parts of this section are employed 
in reasoning upon the comparative effects of these 
applications. I think Mr Home reasons on this 
Aa3 



374 

subject with much accuracy ; but he seems in his 
practice to forget to distinguish the very circum- 
stances upon which his reasonings turn. 

In p. I73, he informs us, that " it often hap- 
pens, that when there are several strictures, the ap- 
plication of the caustic to that which is nearest the 
external orifice, affects all the others, and makes 
them relax, so that the stream of urine which be- 
fore had been very small, shall now be large and 
free ; and after this has been destroyed, and the 
caustic is applied to one nearer the bladder, the ve- 
ry contrary effect is produced." This he calls sym- 
pathy between parts. That sympathy between parts 
may cause a slight constriction or relaxation of them 
appears to me very evident ; but how it should 
cause so complete a relaxation of the constricted 
part, as to allow the stream of water, before small, 
to become " large and free," is beyond my compre- 
hension. Permanently constricted parts become, 
in some measure, like natural cavities, which force 
or continued pressure may enlarge to a great ex- 
tent ; but sympathy seldom, 1 may say never will, 
particularly in parts such as the urethra, destitute 
of muscularity, and over which the will has no pow- 
er. The truth of the matter is just this, the rea- 
soning of Mr Home can only be applied to a spas- 
modic affection of the part, altered in its mode of 
action for the moment, by the caustic application, 
which also caused all those spasms nearer the blad- 
der to disappear. The contrary effect produced, as 
asserted by Mr Home, when the caustic is applied 
to one still nearer the bladder, can never be ac- 
counted for by any process of reasoning with 
which at least I am acquainted ; it must have been 
owing merely to some accidental occurrence. That 
many curious facts must have occurred to Mr 
Home in his practice, I have no doubt, but no per- 
son should even attempt to establish a doctrine up- 
on an anomalous fact. 

In perusing the I96 pages of Mr Home's first 



375 

volume, it has been observed, that numerous 
spasmodic strictures have by him been considered 
as permanent, and treated accordingly ; and even 
where caustic is recommended for their removal in 
preference to the bougie. It may surprise some to 
find, under the head of " circumstances under 
which the use of caustic has proved unsuccessful,'* 
spasmodic stricture ; — spasmodic stricture, then, 
may be incurable by the caustic ! ! Spasm of these 
parts may be subdivided into six or eight different 
kinds, and complicated in a variety of ways with 
permanent stricture ; but will this be satisfactory to 
such readers as choose to reason for themselves ? 
No. 

Some observations in Mr Home's works seem of 
a paradoxical nature. It is asserted in various parts, 
and cases detailed to prove it, that the application 
of caustic for the removal of stricture does not 
bring an irritation ; in other instances, as in p. 196, 
we find that it did bring an irritation. But perhaps 
during the composition of the book, cases of diffe- 
rent result may have occurred to Mr Home, which 
shows the danger of making statements too general. 

To make remarks on all Mr Home's cases that 
follow this part of his book, would be unpleasant to 
myself, and perhaps uninteresting to my readers : I 
shall, therefore, particularly refer to or detail only a 
few, to which he has given the name of permanent 
stricture, or such as he deemed incurable by means 
of the caustic. In this very dry part of his subject, 
I may have overlooked a number of cases to my 
purpose ; but I believe those I shall subjoin, will be 
found quite satisfactory in respect to what, in the 
previous pages, I have endeavoured to prove. 

In p. 210, Case v. appears one of simple gonor- 
rhoea, in which the increased contraction of inflam- 
ed parts, caused the belief of stricture, which led 
Mr Home to a train of unnecessary and severe prac- 
tice. 

Aa4 



376 

Case vii. Is one of gleet. Mr Home for the most 
part informs us, that a gentleman from the East In- 
dies applied to him with a case of stricture, &c. and 
this mode of statement doubtless precludes ques- 
tion ; but sometimes he relates more distinctly the 
history of the case, and shows us that he suspected 
the presence of stricture on very slight grounds. In 
this case, for instance, the patient had a gleety dis- 
charge, incontinence of urine, erections, and noc- 
turnal emissions ; in short, general depravation of 
health, succeeding gonorrhoea. Mr Home suppo- 
ses this to be a case of stricture, and not recollect- 
ing that irritation produces contraction, he, because 
his bougie was opposed by an obstacle which it 
might itself have excited, was certain there was stric- 
ture. Consequently he destroyed all opposition by 
the caustic, and says, " I applied the caustic to this 
stricture three different times at the usual intervals, 
and the passage then admitted a common sized 
bougie. Finding that, in other cases, the passing 
a bougie, under these circumstances, brought on ir- 
ritation, I did not propose the use of it, and left the 
parts entirely to themselves." Now, if he had ob- 
served the circumstances accurately, he would have 
said, the irritation of the bougie and caustic brought 
on inflammation of the urethra, which cured the 
gleet. 

Case viii. exhibits a spasmodic affection of the 
urethra, or rather the sphincter vesicas, which was 
removed by a hemorrhagy which the caustic indu- 
ced ; but might have been equally well, and far 
more easily removed for the patient, by leeches ap- 
plied to the parts. 

In case ix. a young man from the country ! called 
on Mr Home to tell him that he was perfectly cured 
of a stricture. Mr Home advised him never to tra- 
vel without bougies, then introduced one into the 
canal, a contraction was perceived, and Mr Home 



377 

applied the caustic ! ! " The application," says he, 
" was repeated four times before the passage allow- 
ed a full sized bougie to go through the stricture ; 
it was, however, much larger than any that had 
been passed before; I then desired that the parts 
might be left entirely to themselves, and not dis- 
turbed by passing a bougie ; in this state the young 
man ! was at last suffered to return to the country." 
If Mr Home had not disturbed the parts by his bou- 
gie, at a time when the patient had no complaint, 
he must have escaped all the painful and unneces- 
sary treatment to which he was subjected. 

Many of Mr Home's cases of stricture are of a 
singular nature ; there is no impeaiment to the uri- 
nary evacuation, nor any want of retention ; in other 
words, the constricted canal is as wide as usual. 

Case xii. is one of gonorrhoea first, properly 
treated and cured by a judicious surgeon; and though 
the gonorrhoea returned, proofs of stricture are de- 
ficient till after the application of bougies. 

This is a case of mismanaged gonorrhoea running 
into gleet, and protracted four years. One surgeon 
thought it a gonorrhoea, and removed the discharge 
by injections; another supposed it stricture, and al- 
so removed the discharge by bougie ; Mr Home at 
last produced a cure by means of caustic. This case, 
after the gonorrhceal inflammation had subsided, 
was converted into a bad gleet, and as in other ob- 
stinate cases of this nature, the common remedies 
alleviated, but did not remove it, so that when any 
one introduced a bougie, the irritation made the 
canal contract round the instrument, and hence the 
idea of stricture, which in reality only existed while 
the irritation of the bougie continued. At last Mr 
Home, under the idea of curing stricture, cauter- 
ized the canal, and, by this inflammation, removed 
the gleet, which could at first have been much bet- 
ter, and far more easily accomplished in a few 
weeks. 



378 

In this whole section, the proofs of stricture are 
deficient in every case : Case fourth it appears, baf- 
fled even the caustic to remove the discharge, and the 
patient of course remained uncured. This affection, if 
I may judge, not only from my own experience, but 
from that of others in the habit of treating these dis- 
eases, could have been completely cured by the in- 
ternal use of cantharides. 

In the cases of section third, p. 272, it is related, 
that a small tumour like a pea, was distinctly felt in 
the urethra. What is this but the caruncle of 
Wiseman and others ? Mr Home supposes this tu- 
mour to arise from the thickened edge of a lacuna ; 
but I am much inclined to believe, that in all the 
cases of this section, this pea-like body, or some- 
thing similar, was the real cause of the obstruction, 
and that the manifold strictures found in each ca- 
nal, were caused by the irritation of the bougies. 

It apppears that, in some instances, the stricture 
was rather the effect than the cause of fistulas in pe- 
rinoea, as in case v. p. 312, " A gentleman had a 
stricture, which was not known till it had produced 
a fistula in perinoea." 

Mr Home informs us frequently, that the hard- 
ness in perinoea is removed by the application of 
the caustic to the stricture, and the hardness is the 
only proof of the stricture existing (see case v. p. 
314, &c.) But the tumour would have yielded much 
more readily, if the caustic had been applied in 
powder to its own surface externally, or, perhaps, 
even to the application of a blister over the external 
surface of the tumour. It is a fact, which I have 
often seen realised, that a piece of caustic applied, 
for instance, over the surface of a bubo for the pur- 
pose of opening it, a practice adopted by some, di- 
minishes the size of it in one or two days, and, by a 
repetition of the same practice once or twice after- 



379 

wards, the tumour has entirely disappeared without 
bursting. 

In case vi. p. 3l6, a swelling between the anus 
and scrotum, had existed years before a stricture 
seemed to have formed. The case seems to have 
been a gleet, accompanied with occasional spasms 
aggravated by the bougies, and at last cured by the 
inflammation induced by the caustic. This disease 
had remained about nine years : Mr Home con- 
cludes the case thus: " After the removal of the 
strictures in the urethra, a spasm came upon the 
bladder in the middle of the night, and then went 
off." Was not there now as much reason to apply 
the caustic as formerly ? We indeed often find, 
that the same symptoms do not induce a repetition 
of the treatment ; I must conclude that once was 
found enough, although it is not expressed. 

Page 322 is a case of occasional spasm, arising 
from the stimulus of the urine or of the semen, on 
the tender urethra ; and the last case in this sec- 
tion, is a well marked one of inveterate gleet, with 
occasional spasm, at last cured by the caustic. 

Case I. page 338, entitled, Ck Strictures attended 
with complaints of the stomach and eruptions on 
the skin," does not seem to be any thing else than 
an inveterate gleet, accompanied as usual with ge- 
neral debility and depravation of the appetite, &c. 
which affection was removed by the local applica- 
tion of caustic, and the internal use of corrosive sub- 
limate. 

Case IV. page 345, entitled " Stricture with ner- 
vous fever," affords sufficient proof that stricture ex- 
isted independently of the bougies ; but the mucus 
discharge is mentioned indistinctly, and the general 
debility indicate something like gleet. Those who 
consult authors will find, that all the symptoms de- 
tailed by Mr Home, viz. nervous affections, restless- 
ness, quick small pulse, uneasy disturbed sleep, with 
heat in the skin, and mucus discharge ; nay, I may 



360 

add, all the symptoms of hectic fever, are brought on 
by excess of venery, where no strictures exist. In page 
34&, of the same case, " he had," says Mr Home, 
" vo ctppw-ent diffiulty in voiding urine, nor did he 
believe that the stream was smaller than natural?' 
Is the existence of a disease then only to be proved 
by its absence ? 

Case I. page 362, is pronounced stricture, though 
the symptoms seem to be the same as those in Case 
IV. page 357, which is deemed not to be a stric- 
ture ! 

I cannot avoid quoting the following case, page 
36i. " A gentleman," says Mr Home, " aged oO, 
had a frequency in making water, particularly in the 
forenoon, which continued through the day, but went 
off entirely on going to bed, and he did not make 
water till he got up in the morning fi e had also a 
gleet, as it was termed, in consequence of gonor- 
rhoea which had continued upon him for two years. 
From the frequency in making water, and the dis- 
charge ! I was naturally led to suspect there was a 
stricture ! ! and, therefore, examined the urethra by 
passing a bougie. I met with a stricture at five in- 
ches ; this was removed by the caustic ; another was 
found at six inches and a-half, which was also de- 
stroyed ; and the bougie passed with ease into the 
bladder. The parts were now left to themselves, 
and the symptoms continued without any abate- 
ment. At the end of a month, the bougie was pass- 
ed, to ascertain whether the stricture had been en- 
tirely removed, and it passed whh great ease The 
circumstance of the bladder being at ease during the 
whole night, made me suspect srone, which by its 
motion, gave uneasiness, but none when at rest. I 
sounded the bladder, but nothing hard was felt. 
The disease appears, therefore, to be an irritated 
state of the membrane of the bladder, probably 
brought on by the stricture — In this case, there 
was little sediment in the urine. By the use of the 



381 

mephitic alkaline water, the patient has almost en- 
tirely got the better of his complaints." 

This is a simple case of gleet, brought on by go- 
norrhoeal inflammation ; but Mr Home says. " the 
disease appears to be an irritated state of the mem- 
brane of the bladder, probably brought on by the 
stricture." The caustic, however, did not cure this 
patient, for Mr Home concludes the case thus: " i his 
patient has almost entirely got the better of his com- 
plaints." 

Case I. page 3/3, is a very well related and ably 
treated case of stricture and stone in the urethra. This 
case proves, that an irritating substance applied to 
the urethra, makes it contract,so as to form an impe- 
diment to the passing of the substance. 

Case II. page 435, which Mr Home gives as an 
instance of hydrocele, cured by the removal of stric- 
ture, was probably a case of gleet combined with hy- 
drocele. The caustic was applied to the urethra, 
which removed the gleet, by inducing inflamma- 
tion ; and, at the same time, the hydrocele was cured 
by stimulating the vessels of the neighbourhood. 

Case II. page 4/5, very completely proves, that 
irritating substances, such as bougies and the caus- 
tic, may produce very dangerous constrictions in 
the urethra. 

The cases adduced, page 484, &c. in support of 
stricture being the cause of ague, and which disap- 
peared on these being removed, are by no means 
sufficiently supported By a careful examination 
in the early stages of them, it will appear, that the 
patients resided in parts of the world where agues 
are common, and in all probability, in the neigh- 
bourhood of places which give origin to such com- 
plaints ; that on the return of the patients, as has 
been formerly stated, to parts of this country, where 
no such causes operated, they would soon have re- 
covered without the bougie. They were probably 
spasmodic strictures, occasioned partly perhaps from 



882 

the effect of the bougie, and partly from the horror 
into which the patient was put, at the very thought 
of such a barbarous operation. 

The chapter, page 4Q4, on the treatment of 
strictures in the oesophagus, is certainly a very ex- 
traordinary one. If, as I suspect, the disease arose 
from hysteria, combined with affections of the di- 
gestive organs, such severe treatment must have 
been unnecessary. 

As a very great degree of similarity may be found 
in Mr Home's reasoning in both volumes, to be 
even as minute in my examination of the second as 
I have been of the first, (generally as I have treat- 
ed the subject), might lead to unnecessary repeti- 
tion, I shall therefore take notice of but very few 
of Mr Home's cases, as almost enough has already 
been said on that part of the subject. 

Any person who may have read Mr Home's first, 
and as far as page 46 of his second volume, may 
feel surprised, after all his reasoning, and the nu- 
merous cautions held out to others, that even he 
should have fallen into such an error, as he is can- 
did enough to acknowledge in that section. The 
case he has adduced in proof of irritation in the 
urethra, from inflammation in the internal mem- 
brane of the bladder, is simply a spasmodic affec- 
tion. The disease, Mr Home informs us, was mis- 
taken by a surgeon in London for stricture, to 
which he applied caustic, and thus, by destroying 
every obstruction, gave momentary relief, but did 
not in the least remove the tendency to contrac- 
tion. Thus continually harassed, and having suf- 
fered greatly from hemorrhage, the life of the pa- 
tient was brought, into the utmost danger. In this 
state he applied to Mr Home for advice, who was, 
by advice of his patient ! prevailed on to employ 
the caustic, although it had been so frequently used 
before, without yielding any thing more than tem- 
porary relief; and although he, (Mr Home), gives 



383 

it as a case of no disease in the urethra ! but one of 
irritation from inflammation of the bladder, the 
patient at length died, and the following were the 
appearances on dissection. 

Mr Home informs us, that " upon inspecting 
the parts after death, it appeared, that there had 
been no stricture in any part of the urethra ! The 
internal membrane of the bladder was in a st;ite of 
ulceration, particularly the lower part, where the 
ureters enter into it, except a line not broader than 
one-eighth of an inch, extending from each ureter 
to the middle line, where the two streams would 
unite. The orifices of the ureters were in a state 
of ulceration, and inflammation had extended it- 
self all along the internal surface of the left ure- 
ter to the kidney, the pelvis and infundibula of 
which were in a state of ulceration." 

" The use of the caustic," he adds, ° had made 
Jive different holes through the membrane of the ure- 
thra ! of the size of the end of a common bougie, at a 
small distance from each other ; and a large abscess 
had formed between the perinaeum and buttock, into 
which the urine escaped by these orifices ! !" Good 
God ! what could have tempted Mr Home to make 
such a case known to the world ? Why has he 
exhibited such a mass of blunders and cruelties 
committed, not only by another surgeon, but by 
himself? Why, if another surgeon went wrong, did 
he, by advice of his patient ! persevere in a similar 
plan of practice ? What became of all his advice 
and all his reasoning on such an occasion ? And, 
above all, when he did commit the fault, why did 
he expose himself by exhibiting the urethra with 
Jive holes in various parts to which the caustic had 
been applied by mistake, with a large abscess form- 
ed in the perinaeum from the inflammatory action 
occasioned by the caustic, and the internal mem- 
brane, &c. of the bladder in a state of ulceration, 
probably from the same rude treatment 



384 

It seems, from the history of this case, that, even 
from the very commencement, by the properly re- 
gulated use of internal medicines and external ap- 
plications, (not caustic bougies), this patient might 
have recovered. 

I again urge, that the extreme difficulty of ap- 
plying the caustic immediately to the strictured part, 
independently of every other consideration* is very 
great, and perhaps there are few surgeons capable of 
hitting the mark. The consequences of such an 
error, then, must be extremely frequent. Even by 
Mr Home's own confession, in some of his cases it 
has occurred to him, and, conscious of the danger, 
he makes the following- observation in page 57. 
" To accomplish this, requires great attention on 
the part of the surgeon ; since the smallest inac- 
curacy in the application of the caustic occasions 
it to get beyond the natural boundaries of the ure- 
thra, and the smallest excess of violence brings on 
too much inflammation, and consequently, in such 
thickened parts, a suppression (I suppose he means 
retention), of urine ; while, on the other hand, too 
much mildness prevents the patient from making 
any advance towards recovery." 

These circumstances must render burning with 
caustic an operation of a most ticklish nature, which 
ought never to be attempted till every other ration- 
al method we can devise, has completely failed of 
success, and even then, only by people who know 
what they are doing. 

Case III. page 127, is advanced as a proof of the 
effect oj stricture on the bladder. Mr Home in- 
troduces it thus : " The following case I am par- 
ticularly anxious to lay before the public for several 
reasons ; it was one which Daran and every sur- 
geon since his time had taken charge of without 
success. It was one in which Mr Hunter tried the 



385 

caustic without performing a cure,' &c. This case 
Mr Home has detailed to the length of one hundred 
pages ! and, after all, we find that he was equally 
unsuccessful ! It appears that this was a disease 
of the bladder and left kidney, and of the prostate 
gland, under which the patient had laboured 53 
years. On dissection, we find evidence that the 
affection of the bladder, &c. had extended itself to 
the urethra, which shewed no morbid symptoms, 
except at the very points ivhere the caustic had been 
applied. 

Although, undoubtedly, various substances exist- 
ing in the kidneys, ureters, or bladder, occasion 
great irritation, and often violent contraction of the 
urethra, even when no disease exists exclusively in 
that canal, yet these contractions are almost always 
of a spasmodic nature, often originating in the ure- 
thra itself, in consequence of diseases of that canal, 
by the harsh treatment of the surgeon, or long con- 
tinuance of the disease, sometimesextend their influ- 
ence to the bladder, ureters, or even to the kidneys. 

On inspecting the body of the patient just al- 
luded to after death, the following appearances were 
observed. 

" The urethra had one uniform smooth surface 
throughout its whole extent ; there was no appear- 
ance of contraction in any part of the canal j but, 
upon a minute examination, the spots, where the 
stricture at five inches, and that at seven inches had 
been, could be distinguished by the membrane being 
thin, (of course by the burning with the caustic, not 
by stricture!) and more compact at these parts 
than in any other. The prostate gland was en- 
larged, and several abscesses had formed in its sub- 
stance ; these had opened into the cavity of the 
bladder, and the inflammation they had produced 
had extended itself over the internal rnembr:ine, 
which was crusted over with coagulable lymph. 
This adventitious substance projected every where 
by very irregular processes into the cavity, and por- 
s B 



386 

tions of it had, during life, been occasionally separat- 
ed and voided with the urine." Nor can I doubt 
that the too liberal use of the caustic promoted the 
inflammation, aggravated the symptoms, and hasten- 
ed the death of the patient. 

In page 243, Mr Home gives two cases as in- 
stances of stricture brought on by onanism, in nei- 
ther of which is there proof that stricture existed pre- 
viously to the introduction of the bougies. The first 
case is related in the following manner, page 247. 
" A gentleman who had early addicted himself to 
that pernicious vice, had the following symptoms 
brought on at the age of 21 ; frequent emissions in 
sleep, attended with lassitude, depression of spirits, 
and loss of general health ; headach, inability to ap- 
ply his mind to business or exert himself, for the 
whole of the day after such an effect had taken place. 
These occasionally happened for several nights in 
succession, and then left him for six or seven, but 
that was the longest interval. The event of these 
attacks upon his reasoning faculties was such, as to 
make him completely miserable. I explained to him, 
that I thought it probable the symptoms of which 
he complained arose from a spasmodic stricture im- 
mediately behind the bulb of the urethra" What is 
there in these symptoms from which we could in- 
fer the presence of stricture ? Not the general de- 
bility, lassitude, and depression of mind ; for what 
could pro.duce these more effectually than the inor- 
dinate exertion of these organs every act of which, 
in the most natural way, is succeeded by that very 
state of mind and body ! Not the nocturnal emis- 
sions, for such practices induce these quite indepen- 
dently of stricture (See my cases of this disease in 
a previous part of this work.) I have seen hundreds 
of such instances. Besides, the very diagnostic symp- 
tom is wanting, by which we have a riuht to infer 
the presence of stricture of an) kind, viz. the dimi- 
nished stream of urine. But Mr Home not only 



387 

judges that there is stricture, but predetermines the 
very site of it, " immediately behind the bulb of the 
urethra !" Now, as it appears by Mr Home himself, 
that the urethra was " in an irritable state, and pos- 
sessed of preternatural sensibility," we can easily 
perceive why it was contracted when the bongie was 
forced into it. The complaint of this patient, Mr 
Home tells us, was very much relieved by the caus- 
tic. 

In page 269, we find strictures producing other 
diseases. Section I. is entitled Erysipelas inconse- 
quence of stricture ; and, on examining the case ad- 
duced in evidence of this, it seems probable that it 
was the bougies introduced into the urethra, and 
not stricture, which caused erysipelas. (See case of 
eruption from the bougie in page 2 14 of this work.) 

Section II. p 1y l, is entitled Sciatica in conse- 
quence of Stricture ; and in the next page Mr Home 
tells us, " the application of caustic, and inflam- 
mation from other causes, produce the sciatica, but 
it does not appear to be an immediate symptom of 
the stricture." 

In all Mr Home's speculations respecting perma- 
nent strictures, he has carried none so far as in the 
notions he has entertained of stricture in the aeso- 
phagus. There are few men who do not, at some 
period or other of their lives, entertain very strange 
notions respecting many points of science 5 and it is 
not uncommon for such men even to publish their 
opinions on these subjects, when under the influence 
of these mistakes. But, in general, when they af- 
terwards reflect seriously, it is more honourable for 
them to retract,' than pertinaciously to insist on such 
notions being actually true. 

We find, then, in Mr Home's second volume, 

that he still endeavours to support the notions of 

strictures in the aesopbagus being by no means an 

uncommon disease. He assures us in page 397, that 

b b '2 



388 

these strictures are most common in the earlier pe- 
riods of life, or, he might have added, when the pas- 
sions are most strong, and when hysteria is most 
common ! Mr Home's strictures in the aesophagus 
almost all occurred in females, or in men in general 
of a delicate habit and irritable mind. In other 
words, they are commonly to be found in such per- 
sons as are most liable to violent hysteric affections ! 

The task I have now executed, has occasioned 
me many an unpleasant sensation. I waited with 
the utmost impatience for the publication of every 
book that was announced on the subject of stric- 
ture, in full confidence that some of those authors 
would anticipate what I had to say. I need scarce- 
ly state that I have been disappointed, for these 
works are now in the hands of the public, and may 
be consulted Some of them, indeed, have started 
very strong objections to the use of the caustic bou- 
gie, but none of them have proposed any rational 
plan by which such obstructions could be removed, 
without in many instances occasioning more torture 
to the patient than human nature was capable of 
supporting. 

It is extremely painful for me to make innovations 
on any generally received plan of practice , but I 
could not witness the consequences of the harsh 
plans of treatment which on every hand presented 
themselves to me, without appealing to the public 
tribunal to- avert a repetition of such acts. 



389 



APPENDIX II. 



Diseases which are unconnected with the Generative 
System, but ivkich are, in their nature and treat- 
7nent } in some respects similar to the preceding. 

1. Or Ulcers, &c. 

Ulcers, and other somewhat similar diseases of 
the external parts, like every other complaint, vary- 
in their nature and severity according to the state of 
constitution and age of the patient, their situation 
and the length of time that they have continued. I 
neither treat of, nor do I here include, those which 
arise from a specific cause, such as venereal ulcers. 
Those then enumerated by authors, besides some 
others, are the simple purulent ulcer, the fungous, 
the sinous, the callous, the carious, the cancerous, 
the cutaneous, the scorbutic, and the scrofulous 
ulcer. 

I believe all such affections, except perhaps in 
some few instances on the trunk of the body, to be 
oftener an occasional, though not absolutely a ne- 
cessary, attendant on constitutional derangement, 
than a cause of it. This opinion, I know, is very 
different from that which is generally sanctioned 
among surgeons ; but 1 hope generally received 
opinions have, from that circumstance alone, no 
shackleSi We uniformly observe that there are cer- 
b b 3 



sgo 

tain constitutions, evidently of an unsound kind, 
which, although their possessors may exist through 
life without any external sore, should they suffer 
but the slightest abration of the skin, the part is in- 
stantly converted into an ill conditioned ulcer, ma- 
lignant in proportion to the vitiated state of the pa- 
tient's constitution. We" find, too, that in general 
no external application can permanently, or even 
safely, remove such ulcers. Thus the miserable pa- 
tient (without our even holding the absurd but not 
uncommon notion, of morbid matter floating in the 
circulating fluids,) is, in myriads of instances, doom- 
ed to groan under such a state, during the course of a 
long life. These ulcers, in different persons, and in 
different parts of the same person, often produce a 
discharge of various colour and consistence ; but this 
discharge, although arising from the immediate state 
of the diseased surface, is often also caused by the 
state of ttie general system Thus, therefore, the 
general system is, in these extensive and foul ulcers, 
even more to be attended to than the ulcer itself. 

The nature of scrofulous tumours, which are in 
most cases the forerunners of ulcers, I may remark, 
is peculiar : They are at first indolent, remain even 
years stationary, or swell imperceptibly ; and except, 
perhaps in consequence of cold, when they swell most 
rapidly to a great size, become of a florid redness, are 
exquisitely painful and sometimes suppurate, and 
though not often, discharge healthy pus. Butin gene- 
ral as just stated, they acquire magnitude slowly, as- 
sume a purplish or livid hue, and are seldom acutely 
painful. At length the integuments having become 
thin, they burst, and allow a thin, transparent, glairy 
liquid, mixed occasionally with clots of coagulated 
lymph, puriform matter, or a little blood and serum, 
to be discharged. In this state of action it requires 
the use of the most powerful stimulants, both gene- 
ral and topical, to produce and maintain that action 



391 

in these ulcers, during which healthy granulations 
are formed. 

It appears to me also that sufficient attention has 
never been paid to the sequela of Erysipelas, or of 
what in common language, is called the Rose, al- 
though it is often productive of much distress to the 
patient. 

After the violence of the systematic affection in 
general originally causing this disease, has subsided, 
or what is nearly the same in its consequences, the 
Erythema of Cullen, where the systematic affection 
is wholly in consequence of the local inflammation, 
many instances of both these affections terminate in 
cutaneous ulcerations of the most obstinate and dis- 
agreeable kind, generally upon those parts of the bo- 
dy where the above diseases had appeared externally. 
Independently of every other consideration, the 
great extent of surface which these affections usu- 
ally occupy, renders them very distressing. The legs, 
which are commonly the seat of such complaints, 
are often entirely affected by them, rendering the 
ill-fated patient completely incapable either of occu- 
pation or amusement. Such states of disease often 
continue for many years, and most frequently dur- 
ing the remainder of the patient's life. The parts 
affected in this way assume a livid colour, discharg- 
ing ill-conditioned matter from various parts of the 
diseased surface. In time, longer or shorter, accord- 
ing to the habit of body of the patient, extensive 
ulcerations appear in the parts, causing most acute 
pain, and discharging great quantities of various- 
ly coloured matter. And, from time to time, he- 
morrhage to a great extent occurs, and debilitates 
the patient very much. To these 1 may add the 
immense swelling that almost always affects the 
limbs. 

Bb4 



3Q2 



V- 



Veatment of Ulcers, Is'c. 

When ulcers or diseases of the skin arise from a 
simple cause, such as a wound, bruise, inflammation, 
&c. they are in general much easier removed than 
when they arise from some constitutional cause. 
Even, I may remark, however simple the cause may 
be which occasioned them, if the general health be 
unsound, they, in conformity to the particular tenden- 
cy of the system, degenerate into one or other species 
of the ulcers enumerated by authors. But when ulcers 
arise purely from constitutional derangement, their 
cure is always tedious, and attended with many dif- 
ficulties which in a sound constitution never occur. 
It is to these different states of body which we ought 
to direct our attention, and act accordingly, rather 
than allow ourselves, according to the commonly 
adopted practice, to be almost entirely regulated by 
the external appearances of the diseased surface a- 
lone. 

In a vigorous and healthy state of the system, we 
seldom find ulcers very difficult of cure. If so, it is 
in general from neglect or improper local treatment. 
But when these are obviated, and mild applications 
made ; if the ulcer then does not readily heal, we 
may rest assured, that in addition to them, our other 
modes of cure must be more general. The system 
is then more or less affected, and, if we hope to suc- 
ceed, our means of cure must be as nearly as pos- 
sible proportioned to that derangement. 

I may remark, that it is a good general rule, in the 
cure of these affections, rather to employ means 
which will act on the general system sooner than 
necessary, than be a moment too long in making 
such applications. In the first instance, no harm 
can ensue ; in the latter, nothing but harm and want 
of success must iollovv. 



3Q3 

In every period of the history of surgery, the most 
successful plans adopted in the treatment of ulcers, 
seem all, though unsuspected by their employers, to 
have acted on the same principle ; and in whatever 
manner these various applications have been made, 
whether external or internal, the substances employ- 
ed have either uniformly been of a stimulating qua- 
lity, or the method adopted in their application have 
produced stimulating effects. Of late years, it is 
well known that the adhesive straps and roller have 
been successfully em ployed; and I may mention, that 
it is alone by supporting, and thereby stimulating 
the parts to which they are applied, that these can 
produce their beneficial effects. 

But the natural transition from producing and 
supporting such a state of action by any kind of ex- 
ternal means, to that of effecting the same purpose 
by the internal use of proper medicines, must ap- 
pear very evident to every one. The local action ex- 
cited by the one, must be of much shorter duration, 
and consequently not so effectual as the other. 

It is upon this principle that all stimuli, applied 
internally to sores, &-c. produce similar effects, 
though I have found, so far as my experience goes, 
none of them, in their operation, so permanently ef- 
fectual as the cantharides. 

We often find that, in the treatment of obstinate 
ulcers and eruptions on the skin, the strongest ex- 
ternal applications are quite ineffectual, or even seem 
to produce bad effects, unless judiciously assisted by 
internal stimulants. And many cases have come un- 
der my own care, in which, although the general 
health seemed good, and the constitution sound, 
no attention nor variety of dressing produced any 
good effect till the external means were assisted by 
the general influence of wine, bark, &c. on the sys- 
tem, taken internally. 

The antients made it no secret that the reasoning 
they employed, respecting the cure of the different 



304 

appearances or stages of ulcers, was perfectly me- 
chanical. Every part of the cure is, with all imagi- 
nable formality, laid down as correctly as the rules 
for the making of ouf boots or our shoes. Thus, 
we have applications for promoting digestion, de- 
tersion, incarnation, cicatrisation, &c. But these 
notions havt, at least in name, been consigned to 
well merited oblivion ; and I wish the practice itself, 
even in our own flay, were as thoroughly discarded 
as the names. We would thus bestow, on this im- 
portant department of our art, that simplicity and 
order, from which we may expect the greatest suc- 
cess, instead of a confused incomprehensible jargon 
of nonsense which has been a disgrace, not so much 
of our art, as of those who encouraged and promul- 
gated such qmickery. 

In healing up such openings from which there 
had been an accustomed discharge for perhaps years 
together, by the mere force of external, or at best 
trifling internal means alone, perhaps there might 
be some risk ; for in that instance, the vitiated state 
ot the constitution, either originally or subsequently 
attending them, still remained, and probably was 
even en< reased by that very act. But the subject 
will be very differently viewed when we recollect that 
the more effectual method ot treating ulcers is, by 
principally attending to the constitutional treatment, 
and making our local applications, in most instances, 
only a secondary consideration. Thus we bring back 
the functions of the often emaciated bod) to a state 
ot j erfect health, and the healing of the ulcers isof 
course the consequence of such a change Every 
cause, then, of the complaint being removed, the 
common practice of substituting an issue is quite 
unnecessary, and always troublesome. 

There are certain states or conditions of ulcers 
which may be completely cured by compression ; 
but perhaps I may not be well understood when I 
say healing by compression. For, so far as I know, 



395 

the proper time for the application of adhesive straps 
is neither taught in any course of lectures, nor explai n- 
ed in any surgical work When, in most instances, the 
surfaces of ulcersassume a healthy action, granulations 
shoot out from every part ; but occasionally, these 
granulations are very luxuriant, and elevate them- 
selves greatly above the surrounding parts. When 
this happens, surgeons in general think it necessary 
to reduce these granulations, vulgarly called proud 
Jiesh, by means of caustjc substances. But by such 
a method, they often do more harm than good ; for 
these applications excite too high a degree of in- 
ilammation in the part, and thus retard the healing 
process which it was intended they should promote. 
When the granulations become luxuriant, we should 
know by this very circumstance, that the generative 
powers of the sore are too predominant, which it is 
proper to check, but not to subdue. On such an 
occasion, then, the granulating process being too ac- 
tive, it requires no stimulation ; it is only necessary 
to overcome the protuberance from the inflamed sur- 
face, and this is easily accomplished by adhesive 
straps, or other means which retard growth by com- 
pression, and do not stimulate the surface ; and, ex- 
cept in aedematous limbs, or in debility of blood ves- 
sels, this is the most generally proper occasion when 
compression should be employed. Sometimes, how- 
ever, such growth is so great as to require reduc- 
tion by caustics, and even by the knife, but far less 
frequently than is generally imagined, and, by sea- 
sonable compression, might perhaps at all times be 
prevented. 

When the edges of old ulcers have acquired a 
degree of hardness almost of the consistence of car- 
tilage, (a circumstance which not unfrequently hap- 
pens) I have used caustic with advantage, and even 
have been obliged to separate these hard portions 
with a knife. 

With these, and the properly regulated use of 
cantharides, I never have failed in the entire re- 



3Q6 

moval of snob affections- I may here mention, that 
I have sometimes ob*< rved a peculiarity of action on 
diseased surfaces to a considerable extent, and which 
internal medicines, however long continued, will I 
believe never overcome. But when in such cases 
the system has been sufficiently excited by the in- 
ternal use of eanthfa rides, (but not till then) and then 
the vessels destroyed on the diseased surface by the 
application of a blister or similar application over it, 
I have never failed of complete success. 

In considering gleet, leucorrhosa, &c. it seemed 
to me that they depended on a certain local affec- 
tion, accompanied by a greater or less degree of ge- 
neral debihfjr. In considering also the treatment of 
these diseases, it appeared that, when obstinate, they 
resisted all common means, even of the most active 
kind ; but that the cantharides excited such a de- 
gree of inflammatory action, as induced a cure in a 
manner precisely resembling that in which diseased 
surfaces are healed. The application of these facts 
to the treatment of obstinate ulcers, &c. rendered it 
very probable that a similar inflammatory action pro- 
duced in the system, might promote the cure of 
them. 

Accordingly, in cases which defied not only any 
art which I possessed, but equally that of the first 
practitioners in this, and I believe in every country, I 
thought it proper to try how far the internal use of 
the cantharides would be beneficial. 

In the cure of ulcers, I may observe, of however 
long standing, I have never, in the general run of 
thun, found it necessary, according to the usual di- 
vision made by authors, to pay such scrupulous ex- 
actness to the particular head to which they belong- 
ed, as we have all been taught to be absolutely ne- 
cessary. 

Where the neighbouring bones were sound, and 
where cancer and lues venerea were absent, I have 
scarcely found it even proper to make any material 



307 

alteration in the treatment. Whatever alteration 
was necessary, under other circumstances, was mere- 
ly occasional, and depended entirely on some parti- 
cular cause, probably arising from the means em- 
ployed, which was but of secondary consideration. 

I know that, in the internal administration of ean- 
tharides in the cure of ulcers, as in their use in the 
removal of other diseases, an inflammatory state of 
the system will be urged as improper or even as a 
dangerous state for their administration. I may re- 
mark, that authority for some time awed me in these 
as in some other matters ; but since 1 have, in many 
instances, relied on these only when evidently ra- 
tional, I have found perplexity and even inconsis- 
tency in some measure disappear. I have, I am 
pretty certain, used the cantharidesin greater quan- 
tity, and I dare say under greater variety of circum- 
stances, than perhaps any one else, and I have never 
found them, when judiciously applied, capable of pro- 
ducing any injurious effect, however long used. 

I hope I shall ever entertain a proper respect for 
authority ; but this respect I believe to consist in 
countenancing itonly while it outstrip not reason, and 
always has actual experience and observation to re- 
commend it. I also hope I shall never be intimi- 
dated by any name from stating what opinions seem 
to me correct, however different these opinions may 
be from the generally received opinions of the day. 

CASE. 

A Gentleman, aged 45, received a blow on his 
right leg, a little above the ankle, which caused in- 
flammation, and afterward an open ulcer. In a few 
months, three other ulcers broke out on the same 
leg, all of which discharged thin matter, and the leg 
became of a dark livid colour, from the ankle ex- 
tending to within two inches of the knee joint, and 
a watery fluid issued from almost the whole of the 



393 

discoloured surface. He was advised to take bark, 
and to use sea bathing ; but he derived no benefit 
from them. 

A year after the accident, the other leg, without 
any visible cause, became affected in a similar man- 
ner, and for their cure he employed a great many ap- 
plications. The sores of his legs sometimes were 
covered with a thin pellicle, but never remained so 
above a few days. 

When I was consulted, his legs were considerably 
swelled, particularly about the ankles, of a dark brown 
colour ; and on each leg there were three round ul- 
cers, every one about an inch and a half broad, dis- 
charging thin brown matter. He suffered little or 
no pain, but felt much weakness in his ankles and 
knees. I prescribed the tincture of cantharides, 
which he continued to use for about six weeks, with 
the application of the roller of cotton cloth, from the 
toe to the knee, when he recovered completely. 

CASE. 

A Carpenter, aged 2Q years, about 12 years ago, 
cut his left leg with an adze. The sore had, since 
that time, been frequently skinned over, but it al- 
ways, in a short time after, broke out again. He 
had applied to several medical gentlemen for relief, 
and, after every external application, from the mild- 
est to the most corrosive, had been used without ef- 
fect, he for several years past considered it as incu- 
rable ; and while it permitted him to follow his ordi- 
nary occupation, he was contented. 

This patient had one ulcer near the middle of the 
leg, about 1\ inches in diameter, with thick irregu- 
lar edges, discharging thin brownish matter in con- 
siderable quantity, and Several other sores about the 
size of a sixpence surrounding it ; but these smaller 
ones have only troubled him a year, and they are nei- 
ther deep nor have they thick edges, although they dis- 



399 

charged matter equally unhealthy with the large ulcer. 
The leg and foot were swelled, and about two -thirds 
of its extent was of a livid colour. I therefore pre- 
scribed the tincture of cantharides to be taken in 
sufficient doses to produce the usual effect on the 
urinary organs. 

Various changes were produced in the state of 
these ulcers during the time he employed the can- 
tharides, which was about eight months, when his 
leg entirely recovered, and he was completely able, 
without any inconvenience, to work at his trade. 

CASE. 

A woman, aged 35, of a robust habit of body, 
was, about J8 years ago, affected with erysipelas in 
her right leg, which occupied the whole space from 
the knee to the point of her toes. Leeches were 
applied over the inner ankle, and the wounds made 
by them degenerated into foul ulcers. But these 
soon healed, and the redness entirely disappeared 
from the limb. She still complained of weakness in 
that leg, and being a kitchen servant, and obliged 
to fatigue herself considerably, she was often before 
night scarcely capable of supporting her weight up- 
on it. Two years afterward, she twisted the ankle 
joint of the same leg, and that part of it which had 
been formerly ulcerated, had the skin rubbed off, 
and an astonishing quantity of blood was discharged 
by the opening. This wound, however, was soon 
healed, but the leg was always in a greater or less 
degree swelled for eight years afterward. About that 
time she had another attack of erysipelas in the same 
leg, which she attributed to her living in a damp 
house at that time. This disappeared in about a 
fortnight, and the ulcerated part formerly mention- 
ed, broke out again. It was again healed by the ap- 
plication of ointment, but- still the swelling conti- 
nued, particularly toward evening. 



400 

Eighteen months ago, after undergoing consider- 
able fatigue, the swelling in her leg encreased to an 
amazing extent ; the ulcerations again commenced, 
and varicose veins appeared in different parts of it. 
She became greatly alarmed at this appearance, and 
applied for assistance at the Royal Infirmary of this 
place. There adhesive straps were applied to the 
ulcerated parts, and bandages of cotton cloth were 
used. She was dismissed from the Infirmary per- 
fectly cured in less than a month. 

A few months after she was again exposed to 
dampness and fatigue, and the swellings and ulce- 
rations in the same place again broke out. She 
again applied at the Infirmary, where the same 
practice was followed as formerly mentioned. From 
this she derived great benefit, and was a second 
time dismissed, cured. A few days after she left 
the house, the ulcerations became much worse, and 
the swelling encreased. This last she kept under 
by bandaging, but the ulcerations continued to ex- 
tend ; and when she applied to me, and gave me 
the above account of her disease, her leg, from about 
a hand-breadth below the knee, to the upper part 
of the foot, was of a livid colour. The varicose 
veins still existed all over the diseased surface, and 
there were two ulcers above the inner ankle joint, 
the smallest being about an inch in diameter, and 
the other of an irregular form and appearance, and 
about six or eight times the size of the other, both 
of them discharging thin matter. I prescribed the 
tincture of cantharides to be taken in the usual 
doses, and to apply a tight roller of cotton cloth to 
the diseased leg, fromTthe point of the tdes~to her 
knee. This practice was continued nearly two, 
months, when the wounded surface being quite heal, 
she went into the country. A year after this, my 
patient had no return of her complaint, and the 
swelling and livid colour had almost disappeared. 



401 

CASE. 

A stout active, little man, aged 45, wished my as- 
sistance for an inveterate and tedious affection of 
one of his legs. 

Several years ago the wheels of a cart passed over 
him, and broke both bones Of the leg, a little 
below the knee. The soft parts of The leg were 
very much injured ; and, while struggling violently 
at the time of the accident, he had forced the upper 
end of the inferior portion of the fractured bone up- 
wards, and backwards through the integuments. 

The bones were replaced and united, and the la- 
cerations of the fleshy parts also healed ; but the 
limb never returned to its sound state, for it swelled, 
reddened, and was very painful. These symptoms 
were so much moderated by means of bandages, 
that he thought he might venture to use the limb 
without the help of them. But the limb continued 
swoln, particularly about the ankle, and in a few 
months was seized with a painful erysipelatous af- 
fection, and an eruption ; this degenerated into open 
ulcers, which united and formed larger ones. 1 he 
pain continued, the ulcers discharged a thin icho- 
rous matter, which excoriated the neighbouring 
parts, when, through neglect or otherwise, it hap- 
pened to come in contact with them. He used the 
limb, but not without great uneasiness. 

He had employed, with little advantage, every 
internal and external remedy that had been sug- 
gested or prescribed to him. 

In the course of about a year, his leg swelled con- 
siderably, the discharge of thin matter was increas- 
ed in quantity, but the pain abated, and it is now 
several years since any alteration had taken place, 
either in the swelling, discharge, or pain ; but he 
thinks the leg much weaker than the other. 

Being incautiously managed, the portions of the 
broken bone had overlapped each other, so that the 
c c 



402 

inferior portion adhered to the inside of the supe- 
rior portion. The leg was much swelled, the foot 
edematous ; and, from the knee downwards, the 
leg was of a mahogany colour, in many parts of a 
deadly lividness, infested with many sores, some 
deep, others like excoriations, which discharged a 
thin ichorous matter in great profusion ; but he was 
very seldom troubled with any pain in it. I pre- 
scribed for him un°uentum nutriium to anoint the 
surface of the affected parts morning and evening, 
and pills containing the muriate of mercury, three 
to be taken each day ; with instructions to put a 
tight roller of flannel or cotton cloth round the foot 
and leg from the toe to the knee joint ; under this 
plan his leg began to decrease in the swelling, and for 
about six weeks the ulcerated parts looked better. 
During the above period, he twice omitted to take 
the pills for a few days, and the sores evidently 
grew worse. 

For about six weeks the appearances in this case 
seemed to have a favourable aspect, but after that 
the means employed seemed quite ineffectual. 

The circumstances here were very unfavourable ; 
yet, after some reflection, I deemed it proper to try 
what effect the cantharides used internally might 
have in invigorating the limb. I therefore prescrib- 
ed that medicine for him, which he continued to 
use for several weeks, when his leg assumed a more 
healthy appearance, and at length completely heal- 
ed. The livid colour too entirely disappeared. 

This appeared upon the whole a hopeless case, 
not from the long duration of the complaint, nor 
from any particular taint in the constitution, but on 
this account, that it was impossible to remove the 
cause, viz. the overlapped bones very much distend- 
ing the upper part of the limb ; accordingly I in- 
formed my patient, that I intended to give him a 
certain medicine, which I employed in old ulcers 
with great advantage, to try it the limb would be 



403 

strengthened by it ; for, on account of the overlap- 
ping of the bones, I did not think myself warranted 
to promise a complete cure. But what was my 
surprise, when the affected parts gradually assumed 
a more healthy appearance, granulated, formed good 
pus, and received a sound covering ! 

The healing process, assisted by the cantharides, 
presented itself in a very beautiful and instructive 
light. That livid rubor, which occupied the limb 
from the knee to the toes, gradually diminished 
from the knee downwards, and toes upwards, and 
the integuments assumed the colour of those which 
invest sound limbs. 

This is one of the many proofs that we have of 
the great extent to which the parts of the living bo- 
dy accommodate themselves to circumstances ; for 
this limb has become sound, and the muscles per- 
form their office, though the parts of the limb are 
irremediably out of their proper situation. 

About eight or nine months afterward this pa- 
tient's ankle began to swell, and several pimples 
broke out on it. After taking, however, a few 
doses of the cantharides, and bathing the affected 
parts with spirits, with the use of the roller former- 
ly mentioned, he entirely recovered in about a fort- 
night. 

CASE. 

A boy aged 11, small of stature, but of a healthy 
appearance, had, till about IS months ago, enjoyed 
good health, when, without his parents or himself 
being able to assign any cause for it, two phlegmo- 
nous swellings, about the size of a walnut, made 
their appearance on the outside of, and rather below 
the elbow joint. They broke, and the discharge, 
which was small in quantity, was of a thin consist- 
ence. He applied at the Royal Infirmary of this 
place, where he was ordered to dress the sores with, 
c c 2 



404 

the calamine cerate of the shops. He continued 
this application three weeks without seeming to de- 
rive any benefit from its use, when another phelmon 
made its appearance three inches farther up the 
arm than the former, which likewise broke, and dis- 
charged matter of a similar consistence. The same 
kind of dressings which were employed in the other 
sores, were likewise applied to this. 

About three months afterwards, he received a 
kick from a horse on the forepart of the ankle-joint. 
This was followed by considerable swelling of the 
uwler part of his leg, which in a few days terminat- 
ed in a phlegmon near the ankle joint. This broke 
and discharged matter, similar to that which pro- 
ceeded from his arm, and the motion of the joint 
was considerably impeded. He was desired to ap- 
ply poultices around the ankle, and over the sore ; 
but from them he derived no benefit, although he 
continued their use for several weeks. He now be- 
gan to suffer considerably in his general health, and 
another sore, of a similar nature to the last, rather 
more toward the outside of the leg, appeared. Sea- 
bathing, with a great variety of dressings, were em* 
ploved, but from these he derived no benefit. 

When he applied to me, his general appearance 
indicated considerable debility. The above-men- 
tioned sores looked remarkably unhealthy ; those on 
the leg, in particular, had thick callous edges, and 
the ankle joint was considerably enlarged and stiff. 
He walked on the point of his toes, and kept his 
knee joint constantly bent, because he could not 
stretch it without occasioning great pain, both in 
the ankle-joint and in the sores. The flexor mus- 
cles of the fore-arm were so much co?itracted, as to 
cause the fore-arm to form a right- angle with the 
humerus. 

As none of the glands on any part of his body 
seemed preternaturally enlarged, and as the ulcers, 
which were evidently of a scrofulous nature, seem- 



405 

ed, in their general character, similar to what I had 
treated successfully with the cantharides, I prescri- 
bed for ham that medicine, and desired him to dress 
the ulcerated parts with simple ointment. He con- 
tinued to be variously affected with that medicine 
for more than seven mouths, when he completely 
recovered During the cure also, he had employed 
various stimulating applications externally. This 
patient had no return of his complaints two years 
afterwards. 

CASE. 

An unmarried lady, aged 21, and of a healthy 
appearance, twisted the elbow joint of her right- 
arm, which gave great pain for two or three days, 
when it abated. The swelling never protruded a- 
bove the size of a walnut. 

Two months after the accident she applied to an 
apothecary of this place, who gave her solutions of 
acet. plumbi ; but she derived no benefit from this 
application, although she persevered in the use of 
it for several weeks. 

She next went to the country, and applied to a 
surgeon, who gave her solutions of the same kind, 
but still without effect 

She now felt considerable pain, extending about 
three inches farther down the arm than the swelled 
spot, or where she first felt the pain In a month 
the swelled spot on the joint began to inflame, and, 
in the course of a few days, broke, and discharged 
a quantity of thin acrid matter. The swelling im- 
mediately fell, and there remained no inequality a- 
bove the skin. She described the opening to be lit- 
tle more than would have admitted the head of an 
ordinary pin, and, upon pressure being applied from 
below upwards, a considerable quantity of thin mat- 
ter flowed out by it ; and unless the sinus was thus 
emptied every morning and evening, the pain wasj 
cc3 



406 

very severe. But the motion of her elbow-joint 
was not impeded for more than a month after, from 
which time she, by the advice of her medical atten- 
dants, used, at different times, various kinds of 
ointments, but never reaped any sensible advantage 
from their use. She also had setons introduced at 
parts somewhat distant from the ulcer, but, as might 
have been expected, she derived no advantage from 
them. 

She came to Edinburgh from the country, and 
gave me the above account of her complaint, and 
the medicines employed to remove it. She said, 
that she never felt any swelling in her neck, axilla, 
or groin, except last winter, when, after having ex- 
posed herself to dampness and cold for a con- 
siderable length of time, she felt several swellings 
on the right side of her neck, one as large as a pi- 
geon's egg, the rest smaller ; but they soon went off. 

There was no other opening than the one already 
described, immediately over the outer condyle of the 
humerus, which scarcely admitted the point of a 
small probe, and still discharged the same kind of 
thin matter, nearly a table- spoonful of which I pres- 
sed out of it. I first introduced a probe, which pas- 
sed along the sinus downwards without obstruction, 
or causing the least pain ; and, on withdrawing the 
instrument, there was an increased discharge of 
thin matter. I next introduced the probe about 
two inches upwards, with the same ease. In 
short, this sinus commenced about two inches 
above the elbow-joint, on the radial side of the 
olecranon, crossed the joint obliquely, and then 
proceeded about six inches along the posterior part 
of the arm, in the direction of the ulna, where it re- 
ceives the interosseous ligament. I laid this sinus 
completely open. On examining, I found other 
three sinuses communicating with the first, and laid 
them all open. 

I dressed the wound once a day with strong oint- 
pient of axunge and the red oxyd of mercury, and 



407 

bathed it with a strong; solution of sulphate of cop- 
per ; neither of these applications gave pain, more 
than five minutes after each dressing. 

I continued to employ similar treatment for about 
three weeks, during which the ulcers often seemed 
to assume a tolerably healthy appearance ; but, on 
examination, finding more extensive and deeper si- 
nuses, I abandoned these, and prescribed the inter- 
nal use of cantharides. 

After continuing the use of this medicine, pro- 
gressively increasing the doses sufficiently to af- 
fect the urinary organs, for about ten weeks, she 
completely recovered. 

During this cure, I made it a general rule to open 
all sinuses the moment T discovered them, and 
washed the wounded surface with spirits, and some- 
times dressed it with escarotic substances. When 
the parts had assumed a great degree of healthy ac- 
tion, I applied pressure to the sinuses with the 
greatest advantage. The glands of the neck and 
axilla swelled ; but, by cold applications, and dimi- 
nishing the use of the cantharides, with the admi- 
nistration of some cathartic medicine, they were 
subdued. 

it is now about four years since I cured this pa- 
tient, she has had no return of her complaints, and 
can use the arm in every respect with the utmost 
freedom. 

CASE. 

A Gentleman, aged 35, lame, and of a weakly 
habit of body, applied to me with a small tumour of 
a livid colour, situated about three inches toward 
the right side of the thyroid cartilage, which evi- 
dently contained fluid matter ; but he would not 
submit to have it opened, and went into the coun- 
try. He soon returned, and informed me that 
the tumour never had increased beyond the size of 
cc4 



408 

a small walnut, ant! had never given him pain. It 
had broke, and discharged thin matter ; and a sur- 
geon in that part of the country advised him to ap- 
ply a poultice for a few days, and afterwards to dress 
the external sore with ung. basilic. He continued, 
however, to observe these instructions, without be- 
nefit, till he came to Edinburgh. On examination, 
I found two small openings discharging thin acrid 
matter in great abundance. J introduced a probe, 
which passed easily forward over the anterior surface 
of the trachea forming a cavity of considerable ex- 
tent. By dissecting off the integuments, I laid the 
sinus completely open, and thus an ill-conditioned 
ulcer was formed, extending three inches across the 
fore part of the neck, and one and a half from above 
downward 1 prescribed the tincture of canthari- 
des, which soon affected him in the usual manner. 
The ulcers were occasionally opened, when any of 
them assumed the appearance of sinuses, and wash- 
ed with spirits. In six months he had completely 
recovered. 

CASE. 

Mrs , aged 44, of a slender habit, ap- 
plied to me for assistance. About a fortnight be- 
fore, she had exposed herself to dampness, and fa- 
tigued herself much. Towards evening she felt 
coldness, shivering, and feebleness. The shiverings 
continued, and she slept very little all night, but 
they went offnext day, and she thought herself much 
better. In the course of a few days afterwards, she 
was seized with stiffness in her neck, and a swelling 
made its appearance about the angle of the jaw, on 
the right side. Several of the glands on the same 
side were affected, and they continued to increase 
in size till I saw her. From the ear to the top of 
the shoulder, the neck was of a dark livid colour. 
Fluctuation being distinctly felt in the tumour, I 



409 

opened it, and there was discharged a large quanti- 
ty of clear thin fluid, mixed with coagulated lymph. 
The internal surface of the ulcer was very extensive 
and deep. I washed it, and injected equal parts of 
tinctura opii and alcohol, which gave very little 
pain, and dressed it externally with simple cerate. 
All the glands of that side of the neck suppurated 
and broke, and several sinuses had formed, which 
were laid open, as far as could with safety be done. 
At length the ulceration and sinuses occupied all 
that side of the neck, and seemed disposed to ex- 
tend in every direction. The whole length of the 
sterno cltido mastoideus muscle was detached, ex- 
cept at its origin and insertion ; and from the whole 
wounded surface, there was discharged thin foetid 
ill-conditioned pus, in great abundance. The most 
stimulating dressings I could think of were now ap- 
plied, and injections of equal parts of tinctura opii 
and alcohol were used twice a day, and bark and 
wine internally ; yet new sinuses were daily forming. 
Though some parts of the wounded surface now 
and then assumed a tolerably healthy appearance, 
this seldom continued more than a day or two, 
when they degenerated again into their former un- 
healthy state 

Every external stimulant application being inef- 
fectual, and the patient's health sinking, in conse- 
quence of the great discharge, 1 began the use of 
the tincture of cantharides internally, in the usual 
doses. 

After she had used this medicine some time, I was 
informed that she had been affected with Jluor al- 
ius for many years, but that she now was afraid of 
it ; for the matter discharged per vaginam was be- 
come very thick. It was found necessary still to 
open some very large sinuses, which run parallel to 
the edges of the sterno cieido- mastoideus, and a deep 
tumour behind the ear, from which pure pus was 
discharged ; and by a probe I ascertained that the. 



4:o 

the matter had insinuated itself between the intersti- 
ces of ihe more deeply seated muscles. By mewns 
of keeping the ulcers on 'he neck clean, and apply- 
ing dressings of simple cente, and pressure, to them, 
wirh the internal influence of the cantharides, the 
livid colour changed into a florid red ; granulations 
formed ; the detached portions of the muscles gra- 
dually adhered ; the fiuor albus disappeared, and she 
was in a few months completely cured of her com- 
plaints, and even now enjoys the very best health. 

CASE. 

A wood-cftter, aged 24, stout made, was about 
seven years ago affected with scrofulous swellings 
in several parts of his body ; but only those of his 
neck suppurated and broke He applied to me on 
the 22d of April i 80(3 ; and as it may be of some 
importance to convey to the reader an idea of the 
general appearance of his disease, I shall attempt to 
describe it. 

On the right side of his head and neck there was 
one ulcer, between the sterno-c'eido-mastoideus and 
masseler, extending from the lobule of the ear to 
the angle of the inferior jaw, and discharging matter 
by two orifices. There was a second ulcer, about 
an inch from the former, situated on the cheek, its 
upper edge being opposite the termination of the 
parotid duct, itself extending downwards, uniting 
with another ulcer under the maxilla, and stretch- 
ing along in that direction. These discharged mat- 
ter by four orifices. Another ulcer was situated be- 
tween the trnpezeus, and stemo-cleido-mastoideus, 
and extending across the inferior extremity of the 
plarysma-myoideus to the sterno-hyoideus. A very 
large ulcer extended from the inferior edge of the 
thyroid gland, over the sternum to the insertion of 
the second pair of ribs, and was covered with scabs 
on this side. There was also an ulcer running 



411 

across under the chin, which united those on oppo- 
site sides. 

On the left side, the ulcers were much more ex- 
tensive than on the other, and not so capable of the 
same description. They seemed, however, to form 
three lines, one commencing behind the mastoid 
process, extending downwards till near the acro- 
mion. The second from behind the lobule of the 
ear to the anterior half of the clavicle ; and the third 
from the zigomatic process of the temporal bone, over 
the masseler and upper part of the p la tysma- my oideus, 
joined as above described with the ulcers of the op- 
posite side. The matter was discharged here by 
numerous orifices, and approached somew r hat to the 
appearance of laudable pus. His neck was in gene- 
ral very much enlarged, it being at least equal in 
circumference to any part of his head. 

The axillary glands were but slightly enlarged, 
but all the glands in both groins, along the course of 
povparts ligament, and extending down upon the 
inside of the thigh, were universally enlarged. 

The disease began by thr- ulcer above the trachea, 
whichbroke about five years ago, after having been in 
a diseased state fully two years; ; and all the other part 
mentioned about the neck becoming also affected, 
broke three years ago The wtyole neck and face con- 
tinued more or less swelled. Thie general health, how- 
ever, continued all the while pretty good, except from 
time to time severe pains in the bowels affected him, 
which were eased by the discharge of flatus down- 
wards. He does not recollect if he was at these 
times costive. / 

When he applied to me, *"$ complained of loss of 
appetite and sickness, in c£p/isequence of which he 
had been unable to work at his trade for several 
months. From the general tendency to glandular 
swellings in this case, i cionceived it more prudent 
to employ the solution o# the muriate of lime, than 
the cantharides ; as in several cases of very large 
glandular swellings, I found this medicine, when 



412 

used in large doses, from four drams to an ounce 
each day, of the greatest service. I know tbat this 
valuable medicine, like many others, has been near- 
ly consigned to oblivion, from an idea propagated 
by men thought to be eminent in their profession, 
that it is possessed of no useful quality : but this is 
not very uncommon in our profession; for, unassist- 
ed by reasoning of any kind, one medicine after 
another has been applauded, has retained its popu- 
larity for a length of time, and, as might be expect- 
ed, has at last been completely neglected. Not 
that the medicine wanted power, but that its em- 
ployers wanted judgment. » prescribed this medi- 
cine to be taken at first in doses of half an ounce 
per diem, to be gradually encreased. I at the same 
time prescribed as tonics, Peruvian bark and carbo- 
nate of iron, to restore the appetite and promote di- 
gestion, desiring that the ulcerated parts should be 
bathed with warm sea water, and dressed with sim- 
ple ointment. 

On the 30th of May J prescribed a solution of 
the sulphate of copper in water, to wash the ulcers, 
and desired that the muriate of lime should be con- 
tinued. A tumor appeared, situated over the jaw, 
and directly under the dens caninus, which in two 
days became as large as a walnut, and seemed com- 
pletely filled with matter. 

On the 7 th of ]u\ie this tumour had shrunk and 
nearly disappeared, without any external opening, 
and the fluctuation of matter was scarcely to be 
felt in it. The ulcers had a more healthy appear- 
ance than he says they have had since the com- 
mencement of the dm ase. No new swellings or ul- 
cers had broke out sinw he began to take the muri- 
ate, and he was nov^ab.le to work at his trade, was 
free from sickness, and tc>ok his victuals well. 

On the 20th 1 repeated the mixture as formerly, 
the patient still continuing to get better. 

On the 11th of July tiie swelling of the glands 



413 

was greatly removed, but the ulceration was worse, 
and very universally spread ull over his neck for the 
most part in small distinct pustules, discharging thin 
white matter. I now determined to give up the 
use of the muriate, and try cantharides, which I had 
hitherto declined doing, on account of the swelling 
of the glands; but, as he was obliged to return to 
the country, before he could arrange matters to stay 
in town during their use, he therefore did not be- 
gin to take them till the gth of August. 

The ulcers were still discharging unhealthy mat- 
ter, and there was a tumour the s.ze of a walnut, al- 
most above the trachea, in which matter evidently 
fluctuated. I prescribed the tincture of cantharides 
to be taken in the usual doses. 

He continued to use this medicine, without any 
perceptible effect, till the evening of the 12th. 
While in bed he felt intolerable itchiness all over 
his body, and, on examining his skin, he discovered 
blotches of the size of a shilling completely covering 
him, and appearing as if he had been stung by nettles. 

On the i3th, he informed me of the above cir- 
cumstance, when the blotches had almost all dis- 
appeared, and he felt a kind of soreness in several 
of the parts where they had been. He had taken 
none of the mixture since last night, being terrified 
lest the blotched appearance of the skin should re- 
turn. The discharge from the ulcer was of a thin wa- 
tery appearance, except in one small spot under the 
right ear, from which thick white matter was dis- 
charged, in greater quantity than was poured out 
by any of the ulcers of a similar size. No effect had 
been produced on the urinary organs. The tumour 
mentioned on the gth broke this morning, and 
discharged thin matter. I ordered a poultice, and 
the recommencement of cantharides in rather larger 
doses, 

On the 15 th, no effect was produced by the can- 
tharides on the urinary organs, nor had the blotches 
troubled him again.- Several of the ulcers discharg- 



414 

ed thin, others thick white matter ; formerly they all 
discharged thin ill-conditioned matter : the discharge 
was likewise increased in quantity, and such was the 
nature of the ulcers, that pressure being made on 
part of his neck formerly described to be in a dis- 
eased state, matter of different colours and consist- 
ence could be squeezed out as if from a sponge ; yet 
a probe passed but a very small way into either of 
the openings. I desired the doses still to be encreas- 
ed, and dressings of simple ointment to be used. 

On the 19th. the probe went much easier into the 
openings than yesterday. In one situated over the 
parotid gland, I could introduce a probe nearly an 
inch all round, and there was discharged from it 
thin matter in considerable quantity. He was now 
very timorous, and would not submit to have it laid 
open. Several of the ulcers, however, were completely 
healed. Some still discharged thin, some thick mat- 
ter, and there were several small papulae, with white 
tops, on several parts of the neck, which never were 
seen before. No effect was produced on the urin- 
ary organs, I therefore desired the cantharides to be 
continued in encreased doses. 

On the 20th, after he went to bed, there was 
some pain in his urinary organs, and difficulty in 
passing water, but these went off before morning. 
I still desired him to continue the cantharides. 

On the 22d, I now judged it necessary to lay 
open the sinus over the parotid gland, but the pa- 
tient would not submit to it. I therefore, for the 
present, declined doing any more for him. 

On the 1st of September my patient' returned to 
me with a determination to submit to whatever 
measures I might think necessary for the removal 
of his complaint. The discharge from all the ulcers 
had become thin, and from some of them it was 
perfectly limpid. I found the formerly mentioned 
sinus over the parotid gland considerably enlarged 
in extent since the 22d, and I made an opening 



415 

from the uppermost to the most depending part of 
it, in length two and a half inches. 1 opened an- 
other about three inches in length, in the direction 
of the sterno-cleido-mastoideus. I likewise opened 
several smaller sinuses, extending two or three lines 
immediately under the integuments of the neck, and 
filled all of these with lint dipped in sp. vini, and or- 
dered him to recommence the use of the tincture of 
cantharides. 

He continued to follow this practice till about 
the beginning of February following, when he had 
completely recovered. 

He is now, (November iSOg) perfectly well, and 
working at his trade. 



II. Diseases of the Skin. 
CASE. 

A man aged 35, about five years ago fatigued 
himself by walking a great deal, which was imme- 
diately followed by a swelling in both legs. The 
skin also broke in several places, and, in the course 
of a few weeks, there was a constant discharge from 
them of a watery fluid, attended with acute pain 
from the knees to the ankles. Mercury was pre- 
scribed, which weakened him very much, but did 
not in the least relieve him of his complaint. After 
he gave over the use of this medicine, the swelling 
began to abate, but the eruption, with the discharge, 
continued to extend upwards to his thighs ; and, in 
a few months, it covered his whole body, and even 
his arms to the points of his fingers. All the dis- 
eased surface discharged thin matter, similar to what 
was at first discharged from his legs, attended with 
some pain, but his legs were always more so than any 



400 

very severe. But the motion of her elbow-joint 
was not impeded for more than a month after, from 
which time she, by the advice of her medical atten- 
dants, used, at different times, various kinds of 
ointments, but never reaped any sensible advantage 
from their use. She also had setons introduced at 
parts somewhat distant from the ulcer, but, as might 
have been expected, she derived no advantage from 
them. 

She came to Edinburgh from the country, and 
gave me the above account of her complaint, and 
the medicines employed to remove it. She said, 
that she never felt any swelling in her neck, axilla, 
or groin, except last winter, when, after having ex- 
posed herself to dampness and cold for a con- 
siderable length of time, she felt several swellings 
on the right side of her neck, one as large as a pi- 
geon's egg, the rest smaller ; but they soon went off. 

There was no other opening than the one already 
described, immediately over the outer condyle of the 
humerus, which scarcely admitted the point of a 
small probe, and still discharged the same kind of 
thin matter, nearly a table- spoonful of which I pres- 
sed out of it. I first introduced a probe, which pas- 
sed along the sinus downwards without obstruction, 
or causing the least pain ; and, on withdrawing the 
instrument, there was an increased discharge of 
thin matter. I next introduced the probe about 
two inches upwards, with the same ease. In 
short, this sinus commenced about two inches 
above the elbow-joint, on the radial side of the 
olecranon, crossed the joint obliquely, and then 
proceeded about six inches along the posterior part 
of the arm, in the direction of the ulna, where it re- 
ceives the interosseous ligament. I laid this sinus 
completely open. On examining, I found other 
three sinuses communicating with the first, and laid 
them all open. 

I dressed the wound once a day with strong oint- 
pent of axunge and the red oxyd of mercury, and 



417 

but soon after his return home his former symptoms 
recurred. 

In this kind of comfortless manner he had lived 
for many years previous to my being called to visit 
him ; and when I proposed to employ cantharides 
internally, he consented to give it a trial, but ex- 
pected no permanent benefit from its use. 

After the medicine had been used about a fort- 
night, he felt slight difficulty in voiding urine, ac- 
companied by a soreness in the affected parts, from 
which there now issued a discharge greatly en- 
creased in quantity, but not altered in colour. The 
pain, though equally severe in the affected parts, 
he soon felt to be of a different nature from that 
which formerly distressed him.* He continued the 
use of the medicine for upwards of six months, with, 
latterly, the use of the tight roller to the affected 
parts, when he had completely recovered. He from 
time to time had slight eruptions for three or four 
months afterwards, but no pain, and now he is free 
even from them, and is perfectly well in every re- 
spect. 

A more detailed account of a few of the preced- 
ing cases, containing their daily progress toward 
their cure, may be found in my former work on the 
internal use of cantharides, and some others since 
that in the Medical and Physical Journal of London 
for October 1808. 

* This excruciating pain I have frequently met with both in 
diseases of the skin and in ulcers. It seems deeply seated, and in 
most instances, as if in the substance of the bone. This at first 
deterred me from using the cantharides in such affections, con- 
ceiving that the inflammatory effects of that medicine would en- 
crease the pain. But, to my surprise, in every case the former 
pain abated on the system becoming affected by that medicine, 
and the pain occasioned by the medicine itself was quite of a dif- 
ferent and more bearable kind. 

DD 



418 

In all those edematous swellings of the legs, which 
so often occur in persons advanced in life, or in con- 
sequence of previous debilitating diseases, I uniform- 
ly effect a cure by the internal use of cantharides. 
After its use, however, for a week or two, I find it 
absolutely necessary to employ a roller or a tight 
laced stocking; along with it, which should encom- 
pass the whole foot and leg to the knee ; and, even 
after the cure has been completed, this application 
oughr not to be laid aside for several weeks, or even 
for a month or two, 

III. Glandular Diseases. 

Diseases of the gl in'dular system, are, even in 
their simplest form, extremely difficult and tedious 
of cure. I am sorry to say, that with our very great- 
est attention, and probably from ignorance of the 
particular action of some of the most valuable 
medicines these diseases often prove irremediable. 
From this circumstance, together with the indolence 
of the human character, in general, those diseases 
have hitherto been in a great measure left to them- 
selves, and have too often produced spectacles of 
deformity and disease scarcely to be met with from 
any other cause. 

From whatever cause, then, the diseased state of 
the glands may have arisen, our first object ( eing 
the simplest and least formidable) ought to be to 
m?ke a fair attempt to remove them by internal me- 
dicines, or in conjunction with simple external ap- 
plications. But, if after this no relief be obtained, 
and the complaint still continues to gain ground, 
we must have recourse to surgical means for its re- 
moval. 

The cantharides must first be taken in sufficient 
doses to excite some degree of uneasiness in passing 
urine. This effect is the surest sign of the system 
in general being affected by the medicine, in the 



419 

same way that opium is known to affect the system 
by its effects on the brain, and mercury by its ef- 
fects on the salivary glands. 

A continuance of the medicine in sufficient doses 
to preserve some degree of uneasiness in the urinary 
organs, will probably at length cause some addi- 
tional uneasiness in the affected gland itself. At all 
events, even if it should not occasion much pain in 
the gland, perseverance in the use of the cantharides 
for four or five weeks will be extremely proper ; but, 
if pain be produced in it before that time, the can- 
tharides must be instantly laid aside, and other means 
adopted. 

It is at this precise period that the solution of 
the muriate of lime may be administered with the 
very greatest success ; and a blister or sinapism may 
at the same time be repeatedly applied over the af- 
fected glands. A dram of the muriate may be 
given in water morning and evening, and gradually 
increased till the doses may amount to from one 
to two ounces daily, divided and taken at three or 
four, or more different times The only bad ef- 
fect that the muriate seems capable of producing, is 
a little uneasiness or sickness at stomach, which 
will entirely abate on its closes being diminished, or 
entirely omitted for a few days. 

Even should the pain in the glands entirely 
abate, the cantharides may be given in conjunction 
with the muriate, and the external application of 
the blister or sinapism may also be had recourse to, 
when the good effects of such active practice ap- 
pears very conspicuous. 

But if, independently of all these meanSj the dis- 
eased gland or glands still continue to encrease, our 
dependence must principally rest on our success- 
ful treatment by surgical means. A complete ex- 
tirpation of the diseased glands must then be effected* 

dtj 2 



420 



IV. Paralysis. 

I have had frequent opportunities of successful- 
ly exhibiting the cantharides internally in slight 
paralytic affections, especially such as is frequent- 
ly to be found among those who are in any way 
exposed, from the nature of their profession, to 
the action of the various preparations of lead on 
the body. But I met with one case lately of a more 
decided nature than I had ever seen before. The 
patient was by profession a house- painter, and in 
the prosecution of his business, both his hands, 
from the wrist joints, became paralytic. He was 
totally unable to use them in any way ; and being 
at that time in London, he applied tor assistance ; 
but, notwithstanding every thing that could be done 
for him, he derived no advantage He at length 
came to Edinburgh, where his relations resided, and 
at the request of a friend of my own, I was desired 
to prescribe for him. 

From the almost complete want of feeling, and 
want of power in his hands, I had but little expec- 
tation of affording him any relief. But, being the 
remedy which occurred to me as the best, I pre- 
scribed the tincture of cantharides, to be taken in 
sufficient doses to preserve some degree of uneasi- 
ness in passing water. : o this was added friction, 
with a brush, to be used twice or thrice daily This 
he continued to do about three weeks, when he 
thought the feeling in his hands was somewhat en- 
creased ; but the power of stretching them out was 
still denied him. 

He continued to take the tincture of cantharides, 
to produce the effects I have stated above, for 
other two months, but derived no additional bene- 
fit from it. I then omitted it, and prescribed a so- 
lution of phosphorus in aether. This he continued 



421 

to take about a month, during which time, he im- 
proved very much, but it also, at this time, seemed 
to lose iis beneficial effects I then resolved to use 
both the cantharides and phosphorus at once, and 
prescribed the first of these to be taken in such 
doses as would, as constantly as possible, keep the 
urinary organs somewhat uneasy, and the latter in 
such doses as would create, as constantly as possible, 
a degree of uneasiness approaching to giddiness in 
the head. Under these medicines, he seemed to 
improve somewhat quicker than formerly, and con- 
tinued to do so for several weeks ; but they also 
seemed to lose their effects on his hands. I still, 
however, desired him to persevere, and the differ- 
ence of these two stimulants appeared very con- 
spicuously in this case. He found it necessary with 
the cantharides gradually to diminish the doses, 
from nearly an ounce of the tincture daily, to about 
one dram and a half; but the phosphorus and aether 
he had now encreased from two drops twice a-day, 
to nine drops thrice a day, while these substances 
seemed to produce similar effects on the head and 
urinary organs, which they did when first they af- 
fected the system. 

lor five weeks, he felt no alteration for the bet- 
ter ; but about that time, a rapid improvement in his 
hands took place. He felt able to stretch them 
very considerably, and the feeling was as acute as 
before he was affected by the disease. I desired 
him still to persevere, and he could now only take 
about half a dram of the tincture daily, while he 
could use 14 drops of the solution thrice a-day. I 
also desired him to use cold sea-bathing from which 
he derived great benefit. 

This patient continued these medicines for a few 
weeks more ; and in a few days more than six 
months from the time he began the use of the tinc- 
D d3 



422 



ture of cantharides, he was able to begin the pro- 
secution of his business. He has now continued 
nearly a year free from his complaint, and can use 
the most violent exertion with his hands. 



423 



APPENDIX III. 



Effects of the Cantharides, with Rules for their 
Administration. 



I. External Application. 

Cantharides, when externally applied in suf- 
ficient quantity, excites great heat, redness, local 
pain, and general uneasiness. They accelerate the 
pulse, and often induce pretty smart fever. At 
length the feverishness abates gradually, and a thin 
serous fluid is effused under the cuticle, which is 
thus raised into vesicles of different sizes. 

This serous fluid being allowed to escape, or even 
being absorbed, the inflamed surface soon assumes 
the suppurative state of inflammation ; pus is form- 
ed, granulations shoot up in different parts, unite 
imperceptibly with one another, receive a thin pel- 
licle as a covering ; and thus the part is healed. 

Besides the effects above-mentioned, vesicatories 
of cantharides often produce the more visually mark- 
ed consequences of their internal administration, 
such as stranguary, &c. 

IT. Phenomena that succeed the admission of Can- 
tharides into the System. 

The pulse is strengthened, the appetite is im- 
proved, the mind is rendered more cheerful, thes 
CD 4 



424 

matter of the discharge from any diseased surface 
becomes opaque, is inspissated, and assumes the 
appearance of pus. 

At this time, a greater or less degree of pain ge- 
nerally affects the parts whence the discharge pro- 
ceeds. This goes off, if the medicine be omitted, 
increases if it continues to be taken, and is kept up, 
if the dose be only diminished. 

In the meantime, the discharge varies in quanti- 
ty ; but, on the whole, diminishes daily, and at last 
disappears ; leaving the parts sound, and capable of 
performing all their functions. 

Sometimes, on taking the first doses of the can- 
tharides, the discharge is increased in quantity ; but 
in general it is diminished ; and the matter general- 
ly evinces inspissation before the inflammatory 
sensations disturb the patient. 

The attack of pain will be at very different times 
in different persons, after they begin to them take 
the cantharides, though they individually take them 
in the same ratio. 
r- The quantity that some can take in a given time, 
j without any sensible effect, is astonishingly great, 
compared with the smallness of the quantity which 
affects others. A perusal of the cases previously 
detailed will shew this. 

III. Action of Cantharides on the Urinary Organs. 

It is generally believed, that cantharides exert a 
sort of specific power on the urinary organs, parti- 
cularly the bladder and urethra ; and this opinion 
seems authorised by the fact, that pain in these 
parts, and stranguary, often speedily, and, if their 
use is continued, always sooner or later supervene 
during their admission into the habit. On more 
minute inquiry, however, we shall be satisfied, that 
this is only a concomitant effect; for in many instances 



425 

the pain and uneasiness are first felt in other parts, 
as in the uterus ; ulcers are brought to an active 
state of inflammation on almost any part of the 
body, before the affection of the urinary organs 
makes its attack. ; and often they are altogether 
cured, without its causing any interruption in the 
administration of the remedy ; to this lei us add, the 
effects on the general system, and the facts ascer- 
tained by Forsten, that the stomach, bowels, blad- 
der, &c were contracted at the sametime, we shall 
be convinced, that the opinion of this substance 
acting specifically on the bladder, is erroneous. It 
is worthy of remark, that, in Forsten's experiments, 
the bladder, urethra, and even glans, were inflam- 
ed, while the kidneys and ureters seemed unhurt. 
How does this correspond with the doctrine, that 
the active part of the substance of cantharides is 
absorbed into the mass of blood, and thence sepa- 
rated afterwards along with the urine in the kid- 
neys ? 

In short, we have ample proof, that they neither 
act specifically on the bladder, nor on the urinary 
organs in general : and that the kidneys and ureters 
are not affected in the same degree with the blad- 
der and urethra. In whatever way, then, we may 
attempt to explain the particular effects which they 
readdy evince in the organs of urine and genera- 
tion, we can have no doubt, that these effects are 
only circumstances attendant on their general ope- 
ration. 



426 



IV. Effects of Cantharides on the General System. 

In investigating the nature of any remedy, we 
must consider its effects on the system in general, on 
the mind, and on the circulations. 

We must consider whether it chiefly Effects par- 
ticular organs and functions; how far these effects 
are modified by certain affections, either local or ge- 
neral ; and in what diseases it is chiefly beneficial. 

To know its comparative merits, we must consi- 
der what other remedies or means produce similar 
effects : whether in kind or degree ; for the changes 
induced in the system, after any substance has been 
received into it, indicate the medical properties of 
the substance ; and the degree of such change indi- 
cates the power of the substance considered as the 
cause. 

As is shewn then, in this work, the cantharides, 
when first taken internally in moderate doses, en- 
livens the functions of mind and body ; increases the 
celerity and force of the circulations; improves the 
appetite, and increases the flowot urine and perspira- 
tion. Nor are their effects lessened by using them for 
any length of time, for I myself have frequently given 
them from a-year to about 18 months, at the expira- 
tion of which the patients had the same stimulant 
effects produced as at first, by perhaps one-twentieth 
part ot the medicine, and were stouter than they 
had been for many years before Nor did thev re- 
lapse into their former debilitated state on entirely 
leaving off the medicine. 

Yet Mr J. Hunter formed the most erroneous 
notion respecting the power of cantharides. 

* " I think," says he, " I have i>een able to as- 
certain this fact, that when the balsams, turpentines, 
or cantharides, are of service, the) are almost im- 
mediately so; therefore, if upon trial they are not 

* Hunter, p. 103. 



427 

found to lessen or totally remove the gleet in five or 
six Hays, I have never continued them longer." 

But, on a comparison of cases, we shall find, that 
they effect a cure often in less than five or six days, 
but more frequently require many weeks, and even 
months, before they produce an effect. 

Mr Hunter had found them sometimes suddenly 
and unexpectedly useful ; and when they did not 
evince their power with equal celerity, he drew the 
impatient conclusion, that when they were not spee- 
dily successful, they were useless ! 

* " Balsams, turpentines, and cantharides," ac- 
cording to another author, " appear to be very per- 
nicious. During their exhibition, the discharge ap- 
parent!) tops. This is owing to the diuretic quality 
of the medium by which the mucus is continually wash- 
ed off, not any suppression oj the discharge Jrorn any 
supposed specific power of these medicines on the uri- 
nary canal ! /" 

This is not the first instance on the records of 
our art, where a man attempts to explain that, of 
the nature of which he is ignorant, and which he 
has not patience to investigate. 

V. Modus Operandi of Cantharides. 

In the facts and observations which I have ad- 
duced, it is evident that cantharides stimulate the 
functions of the system in general ; that the more 
evident changes, as evinced by either local or gene- 
ral phenomena, are of an inflammatory nature; that 
the diseases in which they are chiefly beneficial, are 
those accompanied with debility. 

As to the comparative merits of this substance, it 
appears that the other remedies which are found 
useful in the same complaints in which the can- 
tharides are successfully employed, are all of" the to- 

* Wilkinson on Gleets, ch. ii. p. 9. 



42S 

nic or stimulant kind, and such as promote the ac- 
tivity of the vital and animal functions But all the 
other means have failed, when this last substance 
has proved completely successful. 

We have satisfactory evidence of this in the cases 
of seminal emission, gleet, leucorrhcea, &c. above re- 
lated, but in none more evidently than in those of 
obstinate ulcers ; in which, after every other tonic 
and stimulant medicine had been employed in vain 
to co- operate with the external applications, the 
cantharides were prescrbed, and then the sores as- 
sumed a healthy appearance, requiring no other dress- 
ing but simple cerate, and thus-the cure was com- 
pleted. 

Thus, whether we consider the effects of cantha- 
rides on the general system, when taken internally, 
applied externally, or in comparison with other re- 
medies of a similar nature, we have irresistible tes- 
timony, that they operate powerfully on the whole 
system, inducing a degree of inflammatory action, 
which we are not able to command and maintain by 
any other means with which we have yet become ac- 
quainted, indeed, they are perhaps the strongest 
stimulant we possess, while they neither have the 
heating nor intoxicating quality of wine or ardent 
spirits. 

Cantharides then excite and maintain a certain 
degree of activity in the previously debilitated sys- 
tem ; they produce and maintain that degree of ac- 
tion during which debilitated organs are enabled to 
perform their natural functions, or return to their 
sound state ; and during which also suppurative in- 
flammation renovates the disorganized parts. 

On this principle we can easily perceive, why 
they have been found very useful in cases of great 
debility, either local or general ; and why they 
should be equally beneficial in inveterate sores on 
any part of the body. 

It has long been a great desideratum in the re- 



429 

sources of our art, to have means by which we could 
induce and support such an action in the system as 
would correspond with that during which certain 
parts are regenerated, diseased surfaces healed, and 
their healthful functions restored ; but we have it 
in our power to accomplish this important object 
by means of the properly regulated administration 
of cantharides. 

VI. Rules for the administration of Cantharides. 

The administration of cantharides is to be begun 
in small doses, which are to be gradually increased. 
In the meantime, we must carefully watch the 
changes, which proceed with such uniformity, that, 
if our instructions be obeyed, it is our own fault if 
ever the patient be surprised by untoward symp- 
toms. 

1st, Twenty drops of the tincture, (prepared ac- 
cording to the London pharmacopeia) ought to be 
taken in a glass of water thrice a-day, and each addi- 
tional dose to be increased by two drops till some de- 
gree of uneasiness be felt in passing water, when the 
doses must again be diminished ; or, if the sensation 
be severe, the medicine must be entirely left off, 
till this sensation abates, when it is again to be had 
recourse to, in doses sufficiently great, similarly to 
affect the system. This may be known by the in- 
creased force and frequency of the pulse, as well as 
by the symptom above alluded to. If the difficul- 
ty in passing water become suddenly trpublesome, 
cloths dipt in warm water, or I rather prefer a 
large piece of sponge, dipt in warm water, and ap- 
plied to the belly, and between the thighs, will as- 
sist in relieving it. At such a time, also, a smart 
dose of any kind of purgative medicine may be 
taken. 

2'ly, If pain, or even uneasiness at stomach, be 
produced by the tincture, which in some patients is 



430 

not uncommon, a small tea cup- f til of an infusion of 
chamomile flowers, or an infusion or decoction of 
any of the common stomachic bitters, such as co- 
lumba, gentian, &c taken along with each dose, 
will relieve it. 

3dly, If the appetite be umimpaired, nourishing 
soups, plain roast or boiled meat, fowl or fish, with 
vegetables, simply dressed, are the most proper kind 
of food, with one, two, or more glasses of wine af- 
ter dinner. In some states of great debility, ] have 
found necessary, even for a time, to give about a 
pint of wine after dinner, and the same before going 
to bed. For common drink I should recommend 
soda-water, or, if preferred, simple toast and water. 

4thly, No degree of cold, if the air be dry, can 
do the slightest harm. Cold lavation, or even cold 
bathing, may, if in other respects agreeable, be used 
with the greatest advantage. Moderate exercise on 
foot, or in a carriage, but by no means on horse- 
back, is extremely proper ; but when the effect of 
the tincture has become troublesome, it will be ne- 
cessary to refrain from every species of exercise, and 
to recline much on a sofa. 

The matter of the discharge becomes gradually 
thick and opaque ; this shews us, that the inflamma- 
tory action is begun ; and now We must not conti- 
nue to augment the doses ; but if, as sometimes hap- 
pens, this appearance remains stationary, or even 
goes off, when the dose is not increased, then it must 
be increased, but very cautiously. At length, an 
uneasy sensation is felt about the pubes, uneasiness, 
or even pain in the urethra, sometimes ardor urinae, 
and repeated inclination to pass urine, and the dis- 
charge has the form of laudable pus 

At this time the doses are not to be augmented, 
but are to be dhrinished or stopt, just as the disa- 
greeable sensations increase in severity. 






431 

After the use of the cantharides is left off, if the 
inflammation shall abate, and the discharge become 
more thin, the use of that medicine is to be resum- 
ed, and regulated as formerly ; but if the discharge 
gradually goes off along with the inflammatory ac- 
tion, the medicine is not to be repeated, for the cure 
will be effected without farther assistance. 

Very large doses of this medicine, sufficient to ex- 
cite the urinary organs into violent action, seem 
quite unnecessary for the cure of any disease, and 
scarcely ever occur, except by mistake of the pa- 
tient, or from his too great anxiety to get rapidly well. 
But it is a very pleasant reflection, that, independent- 
ly of the very greatest degree of action into which 
these parts can be put by such over doses, no in- 
convenience or after- distress to the patient was ever, 
under my observation, occasioned by it. he story, 
so prevalent then, of irritation of the bladder, or of 
the neighbouring parts, from the violent, or even as 
has sometimes been talked of, from the slightest ef- 
fect of the cantharides, is ridiculous. I myself have 
never seen it, and I believe it to be only a conveni- 
ent excuse for those who start doubts from ill na- 
ture, and endeavour to maintain them by false- 
hood. 

rersons predisposed to glandular swellings, can- 
not use the cantharides but with the utmost cau- 
tion ; and where the glands are indolent, and of pre- 
ternatural size, it would be very unsafe to prescribe 
this medicine, as inflammation and suppuration of 
these organs would be an almost infallible conse- 
quence. 

To those affected with pain of chest, hard, dry, or 
teazing cough, in short, with symptoms of tubercles 
in the lungs, or of incipient phthisis, the cantharides 
must not be administered 

Regulated thus, we ensure its salutary efficacy, 
without incurring the risk of those pernicious effects 



432 

which attend daring ignorance, or equally culpable 
imprudence. 

I have, in various cases, since the publication of 
my first work on that subject, employed the cantha- 
rides in substance. I have fcund it in every res- 
pect equally beneficial and equally safe as the tinc- 
ture. In some, however, it creates pain in the sto- 
mach, when the tincture can in the same patients be 
taken with impunity. But in no other circumstance 
does it seem injurious. 

The form I use it in is that of pills, each contain- 
ing one-fourth of a grain of the powdered fly. 

VII. Means by which the bad Effects of Canthatides 
are aJeviated or removed. 

If, from inattention, either on the part of the pa- 
tient, or medical attendant, or from any unforeseen 
circumstance, there should supervene strangury, or 
or even complete suppression of urine, great pain in 
the organs of urine and generation, sickness, vomit- 
ing, headach, rapid and strong pulse, &c. warm fo- 
mentations are to be applied over the pubes, and 
smart saline cathartics are to be exhibited, with di- 
luents. 

In my own practice, smart cathartics, with these 
fomentations, have always been sufficient to allevi- 
ate the immediate pressure of distress ; but, no 
doubt, the degree of the antiphlogistic treatment 
must be proportioned to the exigencies of the situa- 
tion. 

Dr Greenfield maintains, that camphor most pow- 
erfully corrects the effects of the cantharides. But 
this remains to be proved. 

He exhibited them together, and others since 
have followed his example 

It appears from the experim nts of Dr Forsten 
on dogs, that camphor taken with cantharides, cer- 
tainly very much diminishes the activity of the lat- 



433 

ter.* Half a dram of the powder of cantharides produ- 
ced death ; f but, the same quantity, given along with 
one scruple of camphor, produced only slight mor- 
bid symptoms, from which the animal completely 
recovered. J When the same dose was given with 
only g*. xij of the camphor, the dog suffered much 
more severely ; he refused food three days, but at 
last recovered perfectly. § Even g. viij. of cam- 
phor seemed to prevent the powdered canthari- 
des from killing the animal ; though, % in another 
instance, the same dose of both proved fatal. || Olive- 
oil and opium also diminish the activity of the can- 
tharides. 

But I do not perceive the utility of giving these 
substances along with the cantharides, since it is pro- 
bable that a small dose without, is equal to a greater 
dose with any of them. 

Before we could consider these substances as an- 
tidotes to the cantharides, the experiment must be 
made in another way ; the cantharides must first be 
allowed to produce the morbid or dangerous symp- 
toms, and then we must try if the camphor, &c. 
will relieve or remove them. 

VIII. Conclusion. 

The medical properties, which I have assigned to 
the cantharides, are by no means consonant to the 
general opinions which no\v prevail, nor are they an- 
ticipated on any solid principles, so far as I have 
been able to ascertain in the works' of the medical 
authors of former times. 

* Exp. 7 th and 11 th , p. 71 and 73. 

+ Exp. 20 th , p. 78. 

% Exp. 21 st , p. 79. 

{ Exp. 22", and 25 th , p. 79 and 31* 

f. Exp. 23 d , p. 80. 

11 P. 87. 

Ee 



434 

For, though the internal use of the cantharides, 
in several diseases, is as ancient as the history of me- 
dicine, yet there has always prevailed great diversity 
of opinion with regard to the consequences of their 
admission into the animal system. 

There is the most positive evidence on record, 
that cantharides have been singularly useful in 
many very desperate instances ; but certainly they 
have often been followed by very alarming and de- 
structive effects. How, then, are we to decide with 
regard to their merits as an article of the materia 
medica ? If their effects were uniformly salutary, 
there could be no dispute about their utility, but there 
is no remedy of this description. If their effects were 
uniformly bad, their use ought to be abandoned; but 
they have at one time proved very salutary, at ano- 
ther very noxious. I have therefore deemed it my 
duty more carefully and scrupulously to observe 
those circumstances in which either event had suc- 
ceeded their administration, in order to know when 
they might be prescribed with safety, and with well 
founded hopes of advantage. 

Cantharides are proved to be a very active stimu- 
lus ; and all the complaints in which they have been 
unequivocally and certainly useful, are those of de- 
bility or the atonic. 

If the administration be too long continued, and 
the doses too great, or if they are administered during 
the prevalence of the phlogistic diathesis, bad conse- 
quences are to be expected : and such is the source 
of the different opinions, or rather mistaken notions 
entertained by authors with regard to this medicine. 
Some have happened to employ cantharides op- 
portunely, with the very best effects ; and others un- 
seasonably, and of course unfortunately. No won- 
der, then, that they have been both extolled and de- 
graded ; but had medical men carefully compared 
the dissimilar circumstances of the cases in which 



A35 

they employed them, the reasons of success or of 
failure would have unveiled themselves. 

Nature is correct and regular in her operations, 
and there is no such thing as chance : renew pre- 
cisely the same causes and circumstances, and the 
event will be invariably and precisely the same. 

Inattention to this mode of procedure has alone, 
I repeat, occasioned that diversity of opinion which 
prevailed with regard to the effects of the cantha- 
rides ; and this inattention, combined with the dread 
of danger, has almost banished them from practice 
as an internal remedy. 

I flatter myself, however, that I have not endea- 
voured in vain to refute the errors which obstructed 
the very great advantages to be derived from the can- 
tharides used internally ; and have assisted in vindi- 
cating the rank they should hold among the most 
valuable resources of the healing art. 

It is now many years since I first began my re- 
searches respecting the nature of this substance, and 
its efficacy in the cure of diseases. My first attempts 
in the way of publication on the subject were on a 
contracted enough scale. But I am happy to find, 
that the principles even then announced, contained 
no erroneous or hurtful doctrine. The faults alone 
lay in my having too contracted a notion of the pow- 
ers of that valuable medicine. Since that period, I 
have in part removed that objection, having pro- 
ceeded somewhat further in my enquiries. Even 
yet, I am far from believing that I have ascertained 
nearly the effects of that medicine ; but I hope I 
shall, by patient perseverance, still farther develope 
their powers. If, however, I am deprived of this, I 
hope the specimen I have given the world will, in- 
dependently of party spirit, or any similar bar to the 
advancement of every valuable fact, follow out these 
researches that the full powers of such an active me- 
dicine may be known. Thus, and by similar inves- 
E e 2 



436 

tigations, we would soon banish from our pharmaco- 
peias that miscellaneous assemblage of drugs which 
can never be of use but to him who wishes tocover 
his mistakes and blunders in a multiplicity of at best 
unmeaning substances ; who can shield himself from 
detection where mystery prevails, but who would 
be afraid to proceed on the principles of simplicity 
and truth, and whose chief occupation is to depre- 
cate improvement. 

Throughout the present work I have adhered 
strictly to the bare statement of facts. Perhaps on 
that account, deprived of the flourishes of eloquence, 
it may to some appear defective. But I have long 
been of opinion, with Mr Home Tooke, that " truth 
needs no ornament ; and, in my opinion, what she 
borrows of the pencil is deformity." 

If my labours, then, or my researches, shall in any 
degree contribute to the alleviation of that wretch- 
edness which either the diseases I have treated of, 
or the wrong treatment of them occasion, I shall be 
amply rewarded. 



437 



EXPLANATION OF THE PLATES. 



PLATE I. 



Fig. I. 
This figure represents a front 
view of the urinary and genital 
parts belonging to a man : 
where each part is (as much as 
possible) preserved in its proper 
situation. 

A. The descending trunk of 
the aorta, or great artery. 

B. The division of this trunk, 
where it sends branches to the 
under extremities. 

C. The twokidneys; of which 
the right is somewhat lower than 
the left 

D. The ascending trunk of 
the vena cava. 

E. The emulgent veins and 
arteries. 

F. The spermatic arteries and 
veins ; which take their rise 
from the aorta, and the vena cava 
and emulgent vessels, and run 
along interwoven with each 
other to the testir'.^. 

G. The ureters j descending 
from the kidneys to the blad- 
der. 

H. The vasa deferentia ; 
which carry the semen from the 
testicles to the vesicul* semina- 
les. 

I. The testicles. 

K. The bladder of urine. 

L. The neck of the bladder j 
which is muscular, and forms 



the sphincter : by means of 
which the urine is retained. 

M. The elevating muscle of 
the penis ; whereby it is fasten- 
ed to the os-pubis : and which, 
contracts the venre penis, so that 
the blood must swell up the ca- 
vernous body of the penis j and 
thus become erect. 

N. O. The musculi directo- 
rs penis •, these are the lateral 
muscles, which contribute also 
to the erection. 

P. The penis. 

Q. The glans. 

K. The inguinal glands. 

S. Part of the intestinum rec- 
tum. 

Fig. II. 

The inside of a kidney. 

A. The body of the glandu- 
lous substance of a kidney ; 
where the urine is formed. 

B. The emulgent artery. 

C. The emulgent vein. 

D. The bason ; into which 
the various ducts pour the urine 
from the kidney, as it is formed. 

E. The ureter ; which car- 
ries the urine to the bladder. 

Fig. III. 

The scrotum ; and the manner 
the testicles are contained in it. 

A The testicles, 

B. The spermatic vessels, 
and vasa deferentia. 



438 



C. The peritonaeum ; which 
continues from the abdomen, in 
closing both testicles, though se- 
parately, in ihe scrotum. 

D The scrotum. 

E. The septum which divides 
the scrotum ; and helps to sus- 
pend it. 



Fig. IV. 
The inside of a testicle. 

A. The glandulous substance 
of the testicle. 

B. The skin which covers it. 
C The spermatic vessels. 
D. The vasa deferentia. 



EXPLANATION of PLATE II. 



Fig. I, 
This figure represents the 
membi urn virile in its natural 
position, viewed side- ways 5 in 
order to exhibit the curve of the 
Urethra, as well when the mem- 
ber is erect, as when it is flac- 
id. 

A. The bladder. 

B. Part of the intestinum 
rectum 

C. The anus. 

D. The neck of the bladder. 

E. The urethra ; this part 
from O to C is called the peri- 
naeum, 

F. The conjunction of the 
os pubis. 

G. The connexion of the 
erectores, &c. 

H, The pubis. 
L. The abdomen 
M. I he penis when erect. 
N. The glans. 
O. The penis when flaccid 
P. The scrotum. 
Q. Ihe testicle. 
fi. The spermatic vessels. 
S. The vas deferens. 
T. The ureter. 
U. The vesiculae seminales. 

Fig. II. 
Representing that part of the 



urethra which is next to the 
rectum. 

A. A portion of the blad- 
der. 

B. The ureters. 

C. The vasa deferentia. 

D. The vesiculae seminales. 

E. The prostate gland. 

F. Part of the urethra. 

G. The blood-vessels of the 
vesiculae seminales. 

H. 1 he mucous glands. 

I. Two small glands near the 
prostate. 

R. The accelerator ; divided 
in the middle, and expanded. 

L. Ihe bulb of the caver- 
nous body of the urethra, infla- 
ted, and divested of the accele- 
rator muscle. 

M. The third pair of mus- 
cles of the penis. 

N. The musculi directores 
penis. 



Fig. III. 

The cavernous body of the 
urethra, with the glans, slit 
open, so as to see it partly in- 
side. 

A. The cavernous body. 



439 



B. The urethra. 

C. The cavity formed in the 
corpus cavernosum glandis pe 
iiis ; in which the extremities of 
the corpus cavernosa penis are 
received. 

D. The upper part of the 
glans. 

E. The glans. 

F. The frsenum. 



Ftg. IV. 
Shews the situation of the in- 
guinal glands, and the neigh- 
bouring parts. 

A. The glands. 

B. The testicle. 

C. The sartorius. 

D The rectus femoris. 
E. The triceps. 



EXPLANATION of PLATE III. 



AAA. External surface of 
the bladder 

B. The part of the blad- 
der into which we strike the 
trocar in perforating it from the 
rectum. 

C. The prostate gland. 

D. The vesiculae seminales. 

E. The vasa deferentia 
running into the vesiculae. 

F. The ureters which en 
ter the bladder about an inch 
behind the vesiculae and toward 
the side of them. 

G. The membranous part 
of the urethra. 

HH. The cavernous bodies ; 
where they rise from the arch of 
the pubis. 



I. These two bodies unite, 
and form the body of the penis. 

K. The pendulous part of 
the bulb of the urethra ; this 
bulbous portion occupies all the 
perineum, and is covered by the 
accelerator urinse muscle. 

L The bulbous part of the 
ure.hra, and the accelerator uri- 
nse muscle cease here. But the 
cellular body (distinct from the 
corpora cavernosa penis) accom- 
panies the urethra the whole 
way, till, at I he point of the u. 
rethra, it is dilated to form the 
glans penis. 

M. The glans. 

N. The fascia; of the penis. 



EXPLANATION OF PLATE IV. 



Fig. I. 

The forepart of a human pe- 
nis prepared ; so as to exhibit it 
in the state in which it is when 
it is erect. 

A. Part of the sphincter ani. 

B. The tfanversales. 

C. The arteries of the penis. 

D. The musculi erectores. 
These muscles are spread, in or- 
der to exhibit them more dis- 
tinctly. 



E. The vena penis. 

F. The corpora cavernosa. 

G. The skin separated from 
the penis. 

g. The lymphatic vessels. 
H. The nerves of the penis. 
I. That part of the skin 
which composes the prae^uce. 
Fig. II. 

A. Part of the penis. 

B. The duplicative. 



440 



C. Glans. 

D. The crown. 

Fig. III. 
The back part of the penis; 
prepared as before. 

A. Part of the sphincter ani. 

B. The musculi transversales 
penis. 

C. The directores, or erecto- 
res. 

D. The corpora cavernosa 
penis. 

E. The corpus cavernosum 
urethrae. 

F. The frsenum. 

G. The glans. 
H. The arteries* 
I. The nerves. 

K. The bulb, covered with 
the musculus accelerator; 

Fig. IV. 
The fore-part of the urethra laid 
open to shew the orifices of the 
excretory ducts of the mucous 
glands 5 and the openings of the 
ureters, and from the vesiculae 
seminales. 

A. Part of the bladder. 

BB. The openings from the 
ureters. 

C. The caruncle, or caput 
gallinaginis ; with the mouth of 
the excretory ducts of the pros- 
tates. 

D. The openings of the 
mucous glands. 

E. Parts of the seminal ves- 
sels. 

F. The vasa deferentia. 

G. The mucous glands. 



H. The bulb of the caver- 
nous body of the urethra. 
Fig. V. 
The vesiculse seminales, and 
vasa deferentia inflated, to shew 
its natural form and cavities. 

A. The inward cavities of 
the vesicle. 

B. The external form . 

C. The vas deferens left 
whole. 

D. The common orifice. 

E. The vas deferens cut 
through. 

Fig. Vr. 
A longitudinal dissection of 
the penis, in order to shew the in- 
ternal part of the cavernous bo- 
dy and the septum. 

A; The corpora cavernosa 
penis. 

B . The septum. 
C; Tht capsula or mem- 
brane. 

D. The corpus cavernosura 
glandis penis. 

Fig. VII. 
A transverse section of the 
penis. 

A. The trunk of the vena 
penis* 

B. The urethra, and its cor- 
pus cavernosum. 

C. The corpora cavernosa 
penis. 

D. The trunk of the arte- 
ries. 

E. The tegument of the 
corpus. 

F. The capsula, or common 
tegument. 



EXPLANATION of PLATE V. 



A. Os pubis. 

B. Os sacrum* 

C. Bladder. 



D. Ureter. 

E. Rectum. 

F. Levator ani. 



441 



G. Anus* 

H. Spermatic vessels. 
I. Testis. 
K. Vas deferens. 
L. Vesiculae seminales. 
M. Their termination. 
N. Prostate gland. 
O. Membranous part of the 
urethra. 



P. One of Cowper's glands. 

Q. Corpus cavernosum cut 
across. 

R. Urethra, with its corpus 
spongiosum cut. 

S. Vena Magna. 

T. Crus penis cut across. 

U. Catheter in the urethra. 



EXPLANATION of PLATE VI. 



A. The external surface of 
the flaccid bladder. 

B. The folds into which the 
bladder falls in this flaccid state. 

C. The eminence which the 
prostate gland makes within the 
bladder. 

D. The cut substance of the 
prostate gland, 

E. E. The caput galinaginis, 



and openings of the seminal 
ducts. 

F.F Enlarged lacunas, which 
in their healthy state secrete mu- 
cus to lubricate the urethra, and 
pour out the discharge in gonor- 
rhoea. 

G. One of these lacunas un- 
commonly large, into which the 
point of a bougie may enter. 



EXPLANATION of PLATE VII. 



Represents a stricture at the 
bulb of the urethra, where the 
sides of the urethra had ap- 
proached each other nearly in a 
point, and where the stricture is 
so narrow, as just to allow a 
bristle to pass through it. 

A. A. The posterior surface 
of the bladder, which is contract 
ed and thickened in its coats. 

B. B. The two ureters near 
their insertion. 

C. C. The two vesiculte se- 
minales, with the vasa deferen- 
tia, not very accurately dissect 
ed. 



D. D. The prostate gland 
somewhat enlarged in its size 

E The urethra at the mem- 
branous part laid open, and sound 
in its structure- A quill has 
been put into it, leading on to 
the bladder. 

F. The urethra near the ex- 
terior extremity of the pent-, in 
a healthy state. 

G. The stricture at the \ ulb 
of the urethra, so narrow a', just 
to allow a bristle to pass through 
it. 

H. H. A part of the crura 
of the corpora cavernosa. 



EXPLANATION of PLATE VIII. 



Represents two strictures in 
the urethra. The one is rear 
the bulb, and the other is with- 



Ff 



in two inches of the orifice of 
the urethra 

A. A. A small portion of 



442 



the bladder, a little thick 1 ed 
in ; ts :oats, with the insertion 
of the ureters vej) observable. 

B B The two side« of the 
prostare gland in a sound state. 

C C. L'he crura of the cor- 
pora cavc:nosa penis divided. 

D D. The corpora caver- 
nosa themselves divided 

E. E. The glans penis also 
divided. 

F The anterior stricture, 
which is of short extent, but the 



inner membrane of the urethra 
is a little irregular and thick- 
ened. 

G. The stricture near the 
bulb, which is nearly an inch 
in length ; the rest of the ureth- 
ra is in a healthy state. 

A. A. The urethra of its na- 
tural width. 

B. The stricture. 

C. C Part of the corpora ca- 
vernosa. 



EXPLANATION of PLATE IX. 



The urethra opened in two dif- 
ferent places, one before the stric- 
ture, the other behind ; the one 
before is through the body of the 
penis ; the other behind, is upon 
the anterior surface of the mem 
braneous part, and a bougie passes 
from t he one opening to the other. 

A. A. The crura penis and 
bulbous part of the urethra all 
blended together by inflamma- 
tion and suppuration, which has 
taken place in many parts. 

B. B. The prostate gland in 
a diseased state. 



C. C. The cut edges of the 
bladder. 

D. The urethra behind the 
stricture very much enlarged, 
irregular on the surface in con- 
sequence of ulceration. 

E E. The cut surface of the 
corpus cavernosum penis. 

F. F, The cut surface of the 
corpus spongiosum urethra. 

G. G. The bougie passing 
from the sound to the unsound 
part of the urethra. 

H. A small bougie in the 
new passage. 



EXPLANATION of PLATE X. 



Represents an ulcer in the 
membranous part of the urethra. 
It is of considerable extent, and 
had destroyed not only the 
coats of the urethra, but the 
integuments at this part. 

A. A. A portion of the blad- 
dei considerably thickened, with 
the fasciculi of its muscular 
fibre? strongly marked. 

B. is. The cavity of th 
pro-tatt gland, enlarged froi^ 
distention in consequence or the 
accumulation of the urine be- 



hind the ulcer. The ducts of 
he prostate gland may be seen 
very much enlarged from the 
same cause. 

C. The ulcer in the mem- 
branous part of the urethra. 

D. A narrow part of the 
urethra, immediately before the 
ulcer, which had been a part of 
(he stricture destroyed by the 
process of ulceration. 

£. E. A part of the corpora 
cavernosa. 



443 



EXPLANATION or PLATE IX. 



Represents a fistula in peri- 
nseo. 

A. A section of the bladder 
very much thickened in its 
coats. 

B. A section of the prostate 
gland, which from the thicken- 
ed state of the bladder, is very 
obscurely marked. 

C. The cavity of the pros- 
tate gland, and of the membra- 
nous part of the urethra, 

D. A fistulous orifice leading 
to a long fistulous canal. 

E. Another orifice, or rather 
short duct, communicating with 
the same canal. 

F. F. the fistulous canal it- 



self, in which there is a long 
slender bristle leading from the 
orifice. 

D. It has one of its termina- 
tions in the scrotum. 

G. Another termination of 
the fistulous canal in the peri- 
naeum. 

H. The stricture in the 
urethra, through which a bristle 
is passed. 

I. The remaining part of the 
urethra. 

K. A part of the corpora ca- 
vernosa. 

L, The scrotum somewhat 
corrugated. 



EXPLANATION of PLATE XII. 



Fig. I. 

Represents a side view of 
the genital parts peculiar to the 
female. 

A. The bladder. 

B. The vagina. 

C. The uterus. 

D. Part of the fallopian tube. 

E. Fart of the rectum. 

F. Mons veneris, 
K.G.N. Pudendum muliebre. 
K. N. The rima magna. 

G. The labiae. 
H. The Nymphae 
I. The clitoris. 

K. The praepuce of the cli- 
toris, 

L. The meatus urinarius. 

M. The orifice ot the vagina. 

N. The perinaeum ; the space 
between the pudendum, and the 
anus. 

O. The anus. 

P. The ureters. 



R. The carunculas myrti- 
formes. 

Fig. II. 

This figure represents the ute- 
rus and vagina ; partly opened. 

A. The uterus ; that part 
next the rectum 

B The inside of the vagina ; 
with the rugae, and the small 
openings of the mucous glands, 
called Lacunae. 

C. The mouth of the uterus. 

D. The orifice of the meatus 
urinarius 

E. The carunculse myrti- 
formes. 

E. The praepuce of the cli- 
toris, 

F The clitoris. 

G. The external part of the 
vagina, 

H. The falopian tubes. 

1. 'the external parts of the 
ovaxia. 



444 



K. The ovaria freed from the 
skin. 

L. The spermatic vessels* 

M. The loose flaps of the tubes, 
called the morsus diaboli. 

N. The broad ligaments j 
properly nothing but a continu- 
ation of the peritonaeum. 

O. The ureters. 

P. The ligamenta rotunda* 

Q. Its extremities ; which are 
fixed at the os pubis, and where 
its ramifications end in the cli- 
toris. 

R. Some of the blood ves- 
sels ; which from the spermatic 
vessels, give their branches to 
the fallopian tubes, and the 
Uterus. 



Fig. III. 

The clitoris) and its appen- 
dages j inflated, as it is in coitu. 

A. The body of the clitoris ; 
distended, as it is with blood in 
coitu. 

B* The great Vein, 

C. The arteries and nerves. 

D. The extremity of the cor- 
pora cavernosa of the crura j cut 
from the ossa pubis. 

E. The musculi erectores cli- 
toridis, freed from the ossa cox- 
endicis, and left at their termi- 
minations. 

F. The crura also distended. 

G. The corpus cavernosum 
pudendi, inflated by the veins of 
the clitoris. 



Finis. 



Printed by John Moir 9 Edinburgh. 



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